Preamble

The House met at Eleven of the Clock, MR. SPEAKER in the Chair.

POSITION OF UNEMPLOYED PERSONS UNDER THE NATIONAL HEALTH INSURANCE AND CONTRIBUTORY PENSIONS ACTS.

11.5 a.m.

Mr. GEORGE HALL: I beg to move,
That, in the opinion of this House, the hardships arising from long—continued unemployment will be unduly aggravated by denial of the benefits conferred by the National Health Insurance and Contributory Pensions Acts, and, therefore, provision should he made for a State contribution towards safeguarding the position of those insured persons who are victims of the present industrial depression.
Of all the attacks which have been made upon the unemployed since this Government came into power, I do not think there is one which has been felt more keenly that the one which deprives them of certain benefits under the Health Insurance Act of 1932. The full effects of that Act were not realised when the Measure was passing through this House, but we have had now an experience of nearly 12 months of its operation, and not only the unemployed, but other persons connected with National Health Insurance, are now fully realising the effect upon unemployed persons. Hon. Members who represent industrial areas, like some of us who sit on these Benches, must have been inundated with letters from their constituents, not only protesting against the effects of the Act, but also asking for information as to how they themselves are going to fare under its provisions. Some of us have had to address quite a number of very large meetings in those areas where, not hundreds, but thousands of men will be affected owing to the fact that they have been unemployed for such a long time.
Then we have such influential bodies as the Federated Association of Insurance Committees of England, Wales and Scotland, who are very concerned about certain provisions of the Act, for not only have they issued a very strong memorandum, but a deputation waited upon the Minister within the last few weeks, when they gave their views and pointed out to him that in their opinion the State is very unfair in doing what it is doing under this Act. Almost all the county insurance committees, local authorities and doctors, now that they
realise the full implications of the Act, are very concerned about it; and, last, but not least, the insured persons, and especially those unfortunate unemployed persons who are coming under the provisions of the Act, are very concerned about it, for already tens of thousands of unemployed persons have been deprived of their rights to sickness and disablement benefit and maternity benefit, and, at the end of this year, they will also lose their medical benefit. National Health Insurance, as the Minister of Health rightly said on the Second Reading of the Bill, is one of the most important of our great schemes of social service. The figures which he gave at the time were really startling, for he said that during the last 20 years no less than £434,000,000 had been expended in benefits. I know of no scheme of social insurance which appeals more to all parties, or enters more deeply into the life of the nation, than this National Health Insurance scheme; it has really become a part of our very national life.
The Minister and his Parliamentary Secretary, in dealing with the Bill both on Second Reading and during the Committee stage, dealt very firmly with the question of keeping the fund solvent. The right hon. Gentleman referred to the report of the Actuary, and said that the actuarial balance between contributions and benefits must be maintained; and he referred to the fact that there was a deficiency running against the fund at that time of something like £2,850,000 per annum, saying that £2,000,000 of this sum was accounted for by unemployment and £850,000 was due to excess of benefits. This, he said, would have to be made up in order to save the solvency of the fund. I would like to ask the right hon. Gentleman whether this investigation by the Actuary was made since the third valuation of the assets and liabilities of the approved societies? Was it made at the time when unemployment was at its peak in this country? If so, I should say that that time, which was quite abnormal, was not a time at which to attempt in any way to place this fund upon what may be regarded as a solvent basis. As far, however, as we are concerned, we say that, whether the investigation was conducted during the third valuation of the assets and liabilities of the approved societies, or during the later
period, 1931–32, this fund would not have been in the condition in which it was just prior to the Act coming into operation had it not been for the action of the Conservative Government in 1926.
Charges were made from this side during the proceedings on the Bill in this House, and reference was made to the fact that in 1926 the State grants to this fund had been reduced by a considerable sum of money. I have before me a statement which has recently been issued, not by any Members on this side, but by the Association of English Insurance Committees, in which they say that in 1926, contrary to the Report of the Royal Commission, the Government reduced their contributions. I am not going into the other points, but the total amount involved in the adjustment was something like £2,800,000 per annum. In addition, they say that, when the national crisis developed in 1931, the Government appealed to the doctors to accept a temporary reduction of 10 per cent. in their remuneration. This reduction meant a saving of £650,000 per annum, and relieved the Treasury of that amount; and, with further savings of about £110,000 secured in other ways, the Treasury has been relieved in all of something like £800,000. Again, we must bear in mind the fact that the National Health Insurance Act of 1926—the Economy Act—transferred to the Chancellor of the Exchequer from the Army, Navy and Air Force Insurance Fund the sum of £1,100,000. A rough estimate has been given of the amount which would have been paid into this fund by the Exchequer had there not been this interference from lt,243 until the present time, and that rough estimate amounts to no less than £30,000,000. We claim quite definitely from this side of the House, that, if the State carried out its financial obligations to this fund, the whole trouble concerning the financial solvency of the fund would not arise.
The Parliamentary Secretary to the Ministry of Health at the time when the Bill was going through the House—not the hon. Gentleman opposite, but the present Minister for Mines—said in the course of the debates that before these reductions were made by the Chancellor of the Exchequer the general financial position of the country was causing
serious alarm. That was in 1926. But at that time the National Health Insurance Fund was in a position of abounding prosperity. If that was the position of the fund at that time, these inroads ought not to have been made, seeing that there was the possibility of this development which has unfortunately taken place; and we say without any hesitation in this Motion that the State should return to this Fund, if not all, a portion of the money which was taken from it as the result of the desire for economy.
The Minister did not attempt to deal with these charges when the Bill was going through the House, for he must know that, had 'these reductions in Government grants not been made, most, if not all, the approved societies would have amassed a surplus sufficient to meet the claims which would now be made upon the funds and would keep the unemployed in the same position regarding their National Health Insurance as they were in before the 1932 Act came into operation. I am not going to deal at any great length with the position of most of the approved societies as they are referred to in the third valuation of approved societies, but it must be agreed that after two years of this reduction in State grants, societies catering for two—thirds of the members were in the position that they had a disposable surplus. Societies representing something like 722,000 members may be regarded as being in a position of deficiency, and, unfortunately, owing to the very long period of unemployment which has existed in the mining districts particularly, mining areas have really to be responsible for a very large proportion of that deficiency.
The Minister, in his reference to this Actuary's report, said that unemployment was responsible for something like £2,000,000 of this deficit. There were only two ways of dealing with this difficulty. We say that the better way, the honourable way, the honest way of dealing with it would be that the State should meet its obligations. The other way, of course, was to attack the poorest of the poor, the weakest section of the community, and, unfortunately for the unemployed and the insured persons, this strong Government, strong in numbers only, not in courage, has decided to collect this £2,000,000 from those who can
least afford to pay it. For how is it to be paid? First of all, tens of thousands of persons have already lost their sickness, disablement and maternity benefit. Then at the end of the year they will also lose their medical benefit unless the Minister will come to their assistance. It is true that the pensions benefit—old age and widows' and orphans' pensions—will continue until the end of 1935, but, notwithstanding that, there is considerable concern in the minds of the vast majority of insured persons as to what their future position is likely to be in this insurance scheme. The Government have now launched their attack against the unemployed. They have commenced to deprive them of certain benefits, and a Government which will deprive them of sickness, disablement, maternity and medical benefit will in their opinion have no scruple at all in taking from them their right to pensions benefit.
I am afraid the Minister of Health and the Government do not realise what this Act means to millions of insured persons. They have during the course of the last eight or 10 years looked upon this Insurance Fund as their shield in time of distress. A large number of people who are insured are unable to make provision for their families by setting aside money or paying for an insurance policy, and only those who are constantly in touch with insured persons, especially the unemployed, fully realise their concern in this matter. They are almost heartbroken with grief at the loss of their employment and the uncertainty of obtaining any in future, and now they are faced with this additional sorrow which they say will force them to seek relief from the public assistance committees for each of the benefits to which they would be entitled under National Health Insurance had it not been for the action of the Government in passing this Bill.
Important as is the loss of sickness, disablement, maternity, and medical benefit, those are not the only effects of this Act with which the unemployed have to contend. During the passage of the Bill through the House very little was said regarding the question of arrears, because it was generally felt by those who had studied the matter that for two years and nine months the unemployed would be entitled to all the benefits under the Bill.
Only those who had been unemployed for a period longer than two years and nine months would feel the effect of these reduced benefits at the commencement of this year. But the Minister, on the Second Reading, said that the approved societies were going to recoup themselves to the extent of something like £1,000,000 as the result of the readjustment of the arrears, which really means that when a person who was unemployed and took his card to the Unemployment Exchange and had it franked, that frank was regarded as being sufficient to entitle him to a contribution. As the result of this Act, the value of the frank has been reduced to a half, so that in the case of an unemployed man who is unemployed for two weeks the two franks on his insurance card will count as one contribution, and he himself will have to pay the additional sum, which works out in most cases at 9d.
But take the case of men who have been unemployed for a long period. I have in my division a colliery where the men have been unemployed for the whole of the last insurance year, from July, 1932, to the end of June, 1933, and they are still unemployed. Their free period of insurance will end at the end of this year. All those men have received arrears cards for 18s. and, unless they pay the arrears, they will be deprived of sickness and disablement benefit during the course of the next year. Not only will it affect those insured persons who are unemployed for a full insurance year, but any person who is unemployed for more than four weeks under this scheme of arrears, unless he pays a certain amount of arrears, will be deprived of a certain amount of his benefits, such as sickness or disablement benefit. That fact was not generally realised throughout the country. There are hundreds of thousands, I could rightly say millions, of insured persons who have suffered unemployment during the last insurance year who have now been called upon, as the result of the operation of this Act, to pay sums varying from 9d. to 18s. a year, and unless they pay those sums there will be a corresponding reduction in their sick and disablement benefits. If they do not pay, say the full 18s, if they have been unemployed for 12 months, it must mean that, although they are within the insurance period,
the extended year, to which they were entitled because they were unemployed, they will not be entitled to those very important benefits. We on this side of the House are very concerned about the provisions of this Act, especially those of us who come from the mining areas. The Minister has said on many occasions that it is not possible to indicate precisely the number of persons who would be affected by this Act. It has varied. The Actuary has, I think, said that the figure would be round about 100,000.

The MINISTER of HEALTH (Sir Hilton Young): In the extension period—80,000.

Mr. HALL: Well about 80,000, but, whatever the number, these persons are not evenly distributed throughout the country, but are mainly confined to those districts where there has been the most serious unemployment during the last four or five years. The great industrial areas, not only the mining areas but the shipbuilding, and the iron and steel areas, all those areas will have to bear the burden. The burden will fall very much heavier in the mining areas seeing that the population there is very much more congested than it is in the other areas which have been referred to by my hon. Friends. Take the case of the county of Glamorgan. There the insurance committee have gone very carefully into the question. They have made a very close study and a very careful inquiry. They found that out of the insured persons in the administrative county of Glamorgan no fewer than 10,066 were affected at the commencement of this year. Those persons were deprived of sickness, disablement and maternity benefits. They will also be deprived of medical benefit during the course of next year unless something is done by the Government. If one takes the administrative county of Glamorgan and the county boroughs, together with that portion of the county of Monmouth where we have the coalfields, almost one—third of the persons who are already affected by this Act will be drawn from those areas. Those are the figures given by persons who are best able to judge. That is not the end of the burden. It is an accumulating burden, for year after year, as the free period and the extended period to which the unem-
ployed persons are entitled expires, there will be an increase in the number of persons who will be affected as the result of being deprived of their benefits under this Act.
In the county of Glamorgan alone, in which 10,066 persons are already affected, the insurance committee estimate that during the course of the year 1934 no fewer than 13,000 additional persons will be affected, making the total number of persons affected in that county alone no fewer than 23,000. Taking into consideration the county boroughs, we must have in the county of Glamorgan, which has suffered more than any other area in the country in the last ten years, particularly in Merthyr Tydvil, Swansea and Cardiff, somewhere between 35,000 and 40,000 people, who, during the course of next year, will be affected by the provisions of this Act. The districts which have suffered most will have to bear the greater loss under this Act of Parliament. No disablement, sickness, or maternity benefit will be paid, and sums equivalent to those benefits will have to be paid out of the rates when these people fall sick or when the wife is confined. Not only so, but as far as these unfortunate people require medical treatment, drugs and so on, they will have, unless the Government intercedes, to rely entirely upon the resources of the public assistance committee—in other words, upon the old Poor Law provisions. These insured persons, as a result of being removed from the care of their family doctors who have been responsible for their medical treatment all their lives—there will be no free choice of doctor, which was the underlying principle of this Act as far as medical attendance was concerned—will be thrown right into the arms of the doctors who are controlled by the public assistance committee. And in those areas where part—time officers are employed it must mean that an increased sum will have to be paid to these people to do the work which, in the opinion of those of us on this side of the House, is the financial responsibility and the duty of the State.
I will deal with the question of medical benefit from the point of view of its cost. The Minister, of course, rightly said that during this year medical benefit is to be continued for those persons who came under the Prolongation of Insurance Act
at the beginning of this year, or were on what may be regarded as the extended period. But the State is not finding the £50,000 which is keeping those people in medical benefit this year. The £50,000 required has been found as the result of the transfer of values in some way. The responsibility of the State really ended at the beginning of this year, and had it not been for those transfer values those persons would have been deprived of their medical benefit even at the commencement of 1933. The Minister must note that those areas which have suffered so much as the result of the depression during the last ten years cannot bear this additional financial responsibility. Even if they could do so they regard it as being unfair that it should be thrown upon them.
The public assistance rate in the County of Glamorgan at the present time is 8s. 5d. in the pound, so high that the Minister of Health during the course of this year—and we are very much indebted to him for the distressed area grant—has given the County of Glamorgan a sum of something like £66,700. But what he has given with one hand he is taking away with the other. He is throwing this additional responsibility upon them, and the proportion of the money which he has already given in the distressed area grant will be taken away from those districts.
We on this side of the House maintain that whatever the cost to the State to maintain these persons in insurance, it should readily be agreed to. The expenditure is of a kind which will not in any way financially embarrass the Government. It is really giving back to the Fund what the Government have taken away from it. It belongs to the Fund. The surplus of the approved societies is very largely the money of some of the members who are at present unemployed and who, owing to the unfortunate depression which has deprived them of their employment, are also being deprived of something to which they are rightly entitled. The cost to the Exchequer of securing the pension rights for the next three years is estimated at £450,000, or £150,000 a year. If there was an additional sum of £50,000 or £60,000 to keep these persons in medical benefit it would mean a cost of £200,000 a year.
The unemployed are bearing the full force of this deficiency, whereas the State
itself is entirely responsible for it. The Minister ought to say to the approved societies and to the unemployed: "This problem is not of your making. We realise that you cannot carry on, and we fully appreciate all the social advantages to be derived from keeping the unemployed persons within the insurance scheme."The unemployed should be treated as those persons who are totally incapacitated through illness and accident. Irrespective of the period during which they are incapacitated, either through sickness or accident, those people still retain their full insurance right. We maintain that unemployment is a social disease and that the unemployed ought not to be called upon to bear this burden because they have suffered unemployment with greater severity than the rest of their fellows. The Government could at very little cost remove this heavy cloud which hangs over millions of people in this country. We appeal to the Minister and the Government to reconsider their attitude regarding this matter, and it is for that reason that I have moved the Resolution.

11.38 p.m.

Mr. LLEWELLYN–1 ONES: I only intend to keep the House for a few minutes. The hon. Member who introduced the Motion has dealt fully and clearly with all the considerations which can be brought to bear upon the Minister of Health to reconsider this matter. Along with all those who have been associated with the administration of National Health Insurance I feel great alarm at what will happen unless the Government do reconsider their position. One cannot help at the present time looking back to the inception of this great scheme. I had the privilege of being associated with the administration of National Health Insurance from the very start. I sat on the first advisory committee set up by the Government and continued to sit on the advisory committees until they were finally dissolved, and I am certain that the promoters of the National Health Insurance Act in 1911 and those who had to do with its administration in the earlier years would have shuddered to think that the condition of affairs which now exists could have come to pass. I think we all appreciate what they had in view. It was not the narrow and
restricted medical service which we have at the present time.
I believe that the vision of the legislators who were responsible for this Act was a very much larger one. They looked forward to the time when the insured person would not merely have the aid of the general medical practitioner but that he would also have the right to consultant service and to the services of an expert surgeon. They also looked forward to the time when the dependants of the insured persons would be entitled to medical benefit, and many of them, I believe, had even a wider vision, and that was the establishment of some kind of a general medical service for the whole population of the country. There was one man who did more than anyone else towards seeing that vision realised. I refer to one of the greatest administrators that this country has ever had, the late Sir Robert Morant, who probably sacrificed his life owing to the energy and zeal which he devoted to this matter and afterwards to the bringing into existence of the Ministry of Health as it at present exists.
The framers of the Act and the early administrators went on a certain basis. Parliament undertook that the Treasury would pay a certain proportion of the cost of National Insurance. I believe I am right in saying that that proportion was 'arrived at by an understanding with those societies who were called upon to administer the Act. While that proportion was being paid there was the possibility of the Act being administered in the spirit and with the intention of its framers, but in 1926 the Legislature thought fit to reduce the Treasury contribution, and from that moment the difficulties of all those concerned in the administration of National Health Insurance begun, and we are to—day dealing with one of the aspects of National Insurance in that connection. I only propose to refer to one aspect of the case, with which I am more directly concerned, the question of medical benefit. Representations have been made to the Minister from time to time during the last few months asking that he should reconsider this matter. It would not mean a very heavy charge upon the Exchequer to deal with all those unfortunate people who, through no fault of their own, will shortly cease to enjoy medical benefit. Those who have appealed to the Minister do not
desire that anything should be done to imperil the finances of the approved societies. We know that the incidence of unemployment has already thrown a burden upon those societies and created serious difficulties for them, but we do 'ask that something should be done to keep these people in medical benefit.
I do not think that anyone fully realises the close attachment which grows up between the workers and their panel doctors. You are going to throw upon the doctors the obligation of giving treatment without any chalice of obtaining remuneration or of asking insured persons who are out of employment to go to the medical officers of the public assistance committees. In many areas, particularly in the distressed areas, these men are over—worked and often paid inadequate salaries. I hope the Minister will reconsider this matter. If he is not in a position to make a direct grant to insurance committees in order to enable them to retain these insured persons within the scope of medical benefit, I trust that he will consider without any delay the possibility of taking another course. The figure given by the Minister of Health, 80,000, will, I think, be found to be far short of the actual numbers.

Sir H. YOUNG: It is not the figure I have given, but the figure given by the Actuary.

Mr. BUCHANAN: Has the figure been changed? Is 80,000 the number of persons who will lose medical benefit at the end of the year? It seems to me that there is a conflict as to the number if the figures quoted by the hon. Member for Aberdare (Mr. G. Hall) for his part of the country are correct.

Mr. LLEWELLYN—JONES: There is no doubt that 80,000 is far short of the figure we shall have to face at the close of this year; and it must be remembered that the greater number included in that figure reside in depressed areas already severely suffering and where the ratepayers are absolutely unable to bear any further burden. The public assistance committee of Birkenhead recently adopted a resolution which was sent to the Minister of Health:
Whereas the public assistance committee is already burdened with the cost of administering assistance to persons in receipt of national health insurance benefit and that
the National Health Insurance Act of 1932 will add to this burden, this joint committee urges the Government to restore the contributions to National Health Insurance funds which were reduced in 1926. Further we are of opinion that the Government should at least continue to provide for the medical treatment of persons affected by recent legislation.
The agitation for the Government to do something has so far come mainly from insurance committees and approved societies, but public assistance committees are beginning to realise the effect which this will have. If the Minister cannot see his way to do something on the lines suggested by the hon. Member for Aberdare, he will find that in the depressed areas the public assistance committee will not be in a position to bear the burden, and then he will have to consider the question of making a grant to these committees. Why should he not make a grant without waiting for such a contingency? It is not a large sum which these insurance committees would require in order to enable them to retain in medical benefit 100,000 persons or 120,000, who will be deprived of it at the close of the year. I appeal to the Minister to give this matter the consideration it deserves, and I hope that he will be able to announce before the debate closes that he is prepared to accede to the oft—repeated request of those associated with the administration of national insurance.

11.51 a.m.

Lieut. —4Colonel MU IRHEAD: It is well, I think, to remember the object of the Act of 1932. Its object was to restore and maintain the financial stability of the National Health Insurance scheme. Many people believe that to talk about maintaining the financial stability of the National Health Insurance scheme is in a sense unreal, because it may mean that you are merely transferring payments from one public fund to another, whether that public fund is national or local. When we were discussing the question on the 1930 Act comparisons were made between the National Health Insurance scheme and the unemployment insurance scheme, and some people pointed to the way in which the unemployment insurance scheme was managed. There was no particular question as to the financial stability of that scheme being main-
tained. On that occasion I said that one of the disadvantages of comparing one form of activity with another in order that they might be levelled up and equalised, was that the tendency almost always was to level down rather than to level up, and I for one had sufficient faith and affection for the structure of National Health Insurance not to want that scheme compared with unemployment insurance. I did not want the unemployment insurance scheme taken as a standard and the National Health Insurance scheme brought down to its level. I am glad to think that if there has been any levelling it has been in the right direction; it has been a levelling up rather than a levelling down. I do not want to stress the comparison between the unemployment insurance scheme as it is administered now and the National Health Insurance scheme as it was administered them, and as we hope it will be administered, because I think the National Health Insurance scheme and the structure upon which it is based is well capable of standing on its own legs.
I do not want to put up arguments for the sake of knocking them down, but there are many people who have not much belief in trying to maintain what is to them the fiction of a financial stability for various sections of national social service. They argue that unless you are going to let people die and starve, which in our present social structure we do not propose to do, it is a fiction to maintain financial stability somewhere at an additional cost somewhere else, but it has been found that there is a very definite advantage in maintaining somewhere or other some block of financial stability. The moment you do that you are able to check abuses and perhaps make justifiable economies elsewhere, which you would not be able to do if you had not maintained a block of financial stability on ordered Lees in one particular direction.
The hon. Member who spoke last said that the last thing he waited was to see the approved societies damaged in any way. I agree with him, and I hope all hon. Members agree with him and me, because I have a great regard and affection for the whole structure of the approved societies under which the scheme is administered. Though it may
appear to some people anomalous to introduce inequality, some societies being richer and others poorer, I believe that the whole structure is a sound one. It is based now on twenty years' experience, and I should be extremely sorry to see anything done which in any way would damage the structure financially. Therefore, I take my stand to—day on the same grounds as were taken when the 1932 Bill was introduced. That is, that in the actuarial calculations let us maintain the financial stability, however open it may be to various interpretations.
Taking that stand, it seems to me that the problem is not to think what changes we may make or what we might do if we went outside the principle of financial stability, but rather to consider whether there are any adjustments which one can make within the orbit of financial stability. That brings me to the question of arrears. I am not in any way going to disagree with the present system by which arrears under unemployment are allowed to count as. half. The hon. Member for Aberdare (Mr. G. Hall) talked about the variations in unemployment. One is pleased to see that these variations are going in the right direction. The hon. Member has to bear in mind that the 1932 Act does allow variations in accordance with variations in unemployment. There is not quite that hard-and-fast, once—for—all rigidity which his remarks rather indicated.
But there is another point apart from that question. There is the question of the period during which redemption of arrears may be allowed. I ask the Minister whether something might not be done to ease the situation very slightly. I am aware that hon. Members may throw stones at me and say that in suggesting that, I am suggesting something which goes outside the orbit of that financial stability on which I take my stand; that is, that if you allow an extension of the period during which a man may redeem his arrears you are suggesting something which will increase the liability falling on National Health Insurance funds, that you may have a larger liability in the future if you allow an extension of the period of redemption. I entirely agree with the hon. Member for Aberdare that you must relate the whole of this question to the incidence and the tendency
of unemployment. I would be chary of making any suggestion about extending the period for redemption of arrears if unemployment did not show the heavy tendency which it does to—day.
If one is to take a stand on the financial stability of the National Health Insurance scheme one must not have an increasing rate of unemployment or even a stationary rate. One must be very careful not to increase in any way the liability which may fall on the Health Insurance fund. But with the immense improvement recently in unemployment figures—and as one can see there is no reason why the figure should not go on improving—there is evidence that some extension might be made in the period of redemption without making inroads on the principle of financial stability to any material extent. My contribution to the Debate is to make that suggestion to the Minister, that he might consider some method of extending the period of redemption. I hope that something may be done in that particular direction.

12.2 p.m.

Mr. BUCHANAN: For importance very few Debates in this House can equal the discussion of this Motion. The three Members for whom I speak support the Motion whole—heartedly. When it was put down there might have been slight criticism of it, but any Motion that is put down to cover this problem would be open to some form of criticism. The Motion represents a point of view which every Member of the House ought to support, that the claim of the unemployed for extra sickness benefit is a just claim. The other day we debated the question of Locarno and treaties with foreign countries, and the House was interested from beginning to end. To—day we are debating an issue of equal importance, one which affects every home in the country, a subject which calls for human consideration just as much as the issue of war and peace, and yet we find the House, comparatively speaking, empty. Apart from the poor attendance the interest of the Press outside and inside of the House is comparatively negligible. When one sees this sort of thing one becomes more cynical as the days go by.
This Motion raises a subject which must be faced. I agree with everything said
by the hon. Member for Aberdare (Mr. G. Hall). There has been a conflict of figures. Either the figures of the hon. Member are wrong or the figures of the Minister are wrong. The hon. Member for Aberdare spoke with truth of facts of which he must have been informed. He told us about that belt of Wales that he knows best. But he did not include figures for the whole of Wales. He quoted figures of over 10,000. But there are Swansea, Cardiff and other places in which there must be large numbers of people affected. When you go further down you have Bristol and the South of England and portions of London. Then there is the North—East Coast, and my experience in the running of my union shows me that the North—East Coast is possibly the most heavily hit district in the country. I say that as one who comes from an area. which has never had anything but poverty and which was a depressed area even before the war. When you add parts of Yorkshire, and Scotland, I cannot see how the Minister's figures are to be reconciled with the present state of affairs. Figures supplied by responsible officials in Scotland to a deputation which interviewed the Insurance Committee in Glasgow showed that in Scotland 50,000 to 60,000 people were likely to be affected. If that be the case, the number for Great Britain must be round about 250,000. The problem is of larger dimensions than has yet been admitted in this House. Even taking the Minister's minimum figure, what does a figure of 80,000 mean? Large numbers of those people are heads of households or have mothers and other relatives and taking that into account, the figure of 80,000 would represent at least 250,000 human souls affected by this Act of Parliament. That is on the Minister's own figure.
What are the benefits affected? The hon. Member who made a very eloquent speech from the Liberal benches confined himself to medical benefit. Medical benefit is important and I may say incidentally that I agree with everything that has been said about the panel doctors. The medical profession is about the only profession which has risen in my estimation since I entered Parliament. I think the services given by the ordinary panel doctor are worthy of the highest com-
mendation from every decent man and woman. I do not blame the Labour party in this respect, but I once heard criticism from the panel doctors from a trade union Member of this House and I felt that it was unfair. I think that the panel doctors from one end of the country to the other are, in difficult and trying circumstances, rendering in the main services of a very noble order. But I do not want the House to regard this merely as a question of medical benefit. There is a tendency to make it a question of medical benefit alone and to make this appear as if it were a ramp by the medical profession to safeguard their panel money.
I trust that we shall remember that other benefits at least equally important if not more important are involved in this issue. In addition to medical benefit there is maternity benefit, there is medicine, there are old age pension rights and widows' pensions rights and there it the question of people in sickness benefit. Every one of these benefits is involved in the issue which we are discussing today. I fear, even more than the hon. Member for Aberdare, the position of the local authorities in this matter. I would not be so much annoyed about the loss of medical benefit if I were sure that the poor people would even get the services of the public assistance doctors. What I fear is that they are going to get no doctors at all; that in the general turnover many of them will be crowded out, and will, practically speaking, get no medical benefit whatever. To—day the average doctor who does Poor Law work is overworked, and the public assistance authorities are grumbling about high rates. I take it that to perform this work properly additional doctors and additional staff may be required. I fear that the authorities may undertake to do this work without the added staff necessary and that numbers of decent men and women will, in consequence, not receive any treatment at all.
There is another misconception in connection with this matter which is worthy of a moment's consideration. I confess that the Minister seems justified in a slight grumble against those who sit upon his own side of the House if, having voted for the Act of 1932, they now ask him to repeal what has been done. Everybody knew what that Act meant. The case for
it, generally speaking, was that it would put the Insurance Fund in a position of financial stability. There is one aspect of that question which is worthy of some thought. That Act excuses every person who is inside the scheme in regard to arrears to this extent, that he is allowed to pay his arrears for 24 weeks, taking the insurance year as 50 weeks. That is to say, a man has to pay 9d. a, week and a woman 8½d. a week for 24 weeks. If a man pays 9d. a week he is paying his arrears as notified by his approved society. But that means that a man may pay as much as 18s. or 24 ninepences in respect of a full year. Since this question has arisen it seems to have been assumed even by Members of this house that that payment of arrears safeguards a man's pension rights. It is assumed that the payment of arrears operates as it would in any other form of insurance. If I am a member of the Prudential or any other society and I clear my arrears, I am immediately in full benefit with that society. That is the case under a life insurance policy. That is insurance. Under this, the man clears his arrears, but, in effect, he is not making himself into a full policyholder. All that it means is that for the forthcoming period no cut will be made in his sickness benefit. It does not safeguard his pension rights or any other position.

Mr. LOGAN: If a man's arrears of contributions are not up to 39, say 38, he must make it up by 12 times at Is. 6d.—18s. If 39, he pays 8s. 3d.

Mr. BUCHANAN: That is true; but the point I want to make is with regard to the arrears themselves. I have found that in this House everyone thinks that the payment of arrears keeps a person. absolutely right for pension rights. That is not the case. As the hon. Member for, the Scotland Division (Mr. Logan), who understands this matter, knows, a man may have a full year's unemployment, he may make up his arrears and then continue for another year's unemployment and pass in time out of insurance. Having, paid his arrears, that brings in nothing at all, though the man may have made a terrible sacrifice to do it. The Minister has made a concession, allowing him to pay by instalments. At first he was not going to allow that, but, in response to friendly society and trade union pressure, he conceded it. But the point is that the
man pays, and then he finds that if his unemployment continues he is in this position.
Take this case. A man round about the age of 57 is unemployed. What chance is there in the Newcastle area, for instance, of getting a job again before 65? I was in the division of the hon. Member who has newly come in for Kilmarnock Burghs speaking to a decent man 58 years of age who had pawned a ring belonging to a girl to pay his arrears. He came to me and said, "I have paid my arrears, and I will be right for a pension, because I do not think I shall get a job again." We talk about insurability. This is the negation even of a business insurance policy. I say this to the Minister. When he is speaking about principles, either run them rightly or do not run them, and whenever a man pays his arrears, at least it ought to bring him within full benefit of every section of the Act.
There is another and a serious aspect in connection with arrears. You are going to ruin the poor approved societies. The Minister made a concession in regard to payments by instalments, but he also made this other concession, that an approved society can use its surplus for the payment. What does that mean? Take a miners' approved society. It cannot do it. Take my society. If we had our members, as we have got them in Birmingham, Coventry and London, we could easily do it, because there is little unemployment in those places. But we have members in Sunderland, half of them unemployed and in Glasgow a fourth. [An HON. MEMBER: "Generally the whole lot.:] Suppose you started to do this, what does it mean as a business proposal It means that every other additional benefit has to be foregone. The consequence would be that every man in regular work, who is the backbone of the society, would leave it, because you would have no additional benefits to attract, and he would go to the most prosperous societies. The result would be that you would be left with only the very poorest members, and the members subject to the greatest unemployment. The powerful societies, who have got the best members from the point of view of work, will become stronger, and the other societies, who are faced with unemployment, must, as a result, become weaker and weaker.
You cannot lose approved members without losing your other business as well. The consequence is that this Amendment means the endowment of the powerful and the rich at the expense of the 'poor.
The last time that this question was raised by the hon. Member for West—houghton (Mr. R. Davies) and myself, the Parliamentary Secretary, in reply, said that the State had dealt generously in that matter. I think that that was the most callous remark I have ever heard in this House. Generously! You have taken the pension away. The Parliamentary Secretary might have said that the State was hard up and was forced to do this, but, for God's sake, do not describe it as a generous measure. You may make excuses for it, but it is not generosity to take away a man's pension, his widow's pension or his sickness benefit. The hon. Member showed a smugness which, I think, ill became him and the office he holds. Whatever may be done here may be forced on you in defence, but it was not a thing done with generosity, or about which one can he smug and complacent. When the Bill passed the House—I have raised this before, and make no apology for raising it again—every Member of the House thought that every man of 60 who was in insurance at the time of the passing of the Act was entitled to his old age pension, no matter how long he was unemployed. I have read the Minister's speech, which did not mislead the House, and that was the common interpretation which everybody put upon it.
What is, in effect, the position? A man has to reach 60 as at the beginning of his extended year. The man who was 60, who passed out of insurance before his extended' year began, has gone, and to—day men who were over 60 at the passing of the Act, but who had not reached 60 at the beginning of their extended year, are passing wholesale out of the scheme. I say that, whatever thoughts this House had, it thought that every man, even if he had been four or five years unemployed, who was inside insurance at the passing of the Act, was safeguarded for his pension for all time when he reached 60. That is not the case, and I say that in that respect people feel that there has been a wrong done.
When all is said and done, this Act has these effects, and the only defence is with regard to financial stability. The hon. and gallant Member for Wells (Major Muirhead) said that the Fund had to be got on to a stable financial basis, and that we could not allow it to become like the Unemployment Insurance Fund. There are two answers to that, and they are simple. One is that his Government of 1925 took from this Fund over £2,000,000, and before you can say, even on a business footing, that the Fund is stable, you must put back the £2,000,000 you took from it. That is one answer, but there is a second answer. Has the Fund to remain the same no matter how circumstances may vary? I say that, in view of the unemployment now existing all over the country, the State contribution fixed when unemployment was low is not the State contribution that should be fixed when unemployment is high. Consequently, I say that, even on a business footing, the Government ought to have provided every penny additional to keep the Fund solvent after unemployment had reached above a certain point.
I regret that the Under—Secretary of State for Scotland is not here at the moment, but the other day he asked me, in private conversation, "Do you think, Buchanan, that the people are more bitter on this matter than they have been before? Do you think there is more feeling? "I said to him, in reply, "I have never seen a matter on which there is more feeling than on this." It is the man passing out, who is married, who feels it. He may die, and he has a terrible feeling about leaving his widow different from other widows. I wonder if there is a chance of a human appeal in this House. We used to talk about segregating the unemployed, but to—day we are engaged in segregating the widows of the unemployed. Under this Act, you would almost think the widow of an unemployed man had committed a crime. Whatever faults may have been attributable to her husband in not looking for work or something of that sort, she has done no wrong, and yet this House of Commons vents its whole punishment on the widow left. She has done nothing, and yet, because she happens to be unfortunately married to a man unemployed, when he dies, she is
not even to receive the pension that other widows receive. Is there a business case for it? Why should she not receive it? Can you argue that she is less deserving or less needy?
No, Sir, I say that there is bitterness to—day, and there is no man in this House who does not know the feeling. Whatever faults mankind may have, a man likes to leave those whom he leaves at least as well cared for as the other people whom he knows. When he walks from this life to another life, and leaves his widow in a more unfortunate position than almost any other widow that he knows of, I think it is a calamity. The two things that I feel worst about are the widows' pension and the old age pension. We shall be engaged to—morrow in celebrating the Armistice, in memory of those who won the War, and to—day we are engaged in a conspiracy to rob some of those who won the War. The hon. and gallant Member spoke about financial stability. You fought the War and provided widows not with an overgenerous pension, but, comparatively speaking, with a better pension than had ever before been given. There was no talk then about financial stability. The pension was 26s. 6d. a week, but to—day other men, some of whom won the War for you and were not killed, are saying, "I wish to God we were killed, because our widows would have got 26s. 6d. instead of nothing."
Many men to—day are cursing that they were not blown to hell, because then their wife and family would have been better off. They won it, they came through it, and they not only fought then, but they have fought since for you, and this is what you do. You will debate disarmament on Monday, and the other day you debated the possibilities of another war. Everybody knows it, and these are the men who fought for you. I often wonder what sort of assembly we are here. Are we really leaving our senses? When you see a Prime Minister elected, coming from the poor, a man who could never have held that office if it were not for the poor, and when you see him and other men here engaged in a foul conspiracy like this, it makes you cynical of all mankind. I say to the House of Commons, and to the Minister, that if he wants to do something that will redound to the credit of this country, something greater
even that his housing policy, greater than anything, and if he wants to do something that will redound to the credit of those who come after him, he will rise and say, "This policy is reversed, and we will safeguard the rights of these decent but unfortunate people."

The UNDER—SECRETARY of STATE for SCOTLAND (Mr. Skelton): As the hon. Member for Gorbals (Mr. Buchanan) mentioned a private conversation with me, I want to state that he volunteered the information.

Mr. BUCHANAN: If I have done anything wrong, I apologise. There was nothing bad about the conversation. I only said that he asked me, and that I told him I thought the people were more bitter.

12.36 p.m.

Sir H. YOUNG: There is one particular in which I can quite agree with the hon. Member for Gorbals (Mr. Buchanan), and that is in regard to the extreme importance of this subject and how worthy it is of the close attention of every Member of the House. I even join with him in wishing that the Debate could have taken place on an occasion when more Members were present to inform themselves of the position. This is a matter which affects very closely the lives of members of the community about whose welfare we are all deeply concerned. I can also agree with the hon. Member that no Member is in a position to say that any of these effects and consequences which we are discussing to—day were unknown or could be unforeseen, because those matters were fully apprehended in the Debate that took place last year when by a decision of Parliament changes were made by the Act of 1932. They were made upon full information and nothing has happened since to alter the position which we then foresaw. The hon. Member for Gorbals was not justified in his attack on the Parliamentary Secretary. There was no single word said by him on the occasion to which he referred which was not fully justified on the facts of the case, and I do not understand the hon. Member's air of moral reprobation. I feel more inclined to adopt it myself, because it was unworthy of the hon. Member's speech that he should have caused confusion on the question regarding pensions. That also, I think, was not
in tone with the rest of the speech of the opener of this Debate, for which otherwise I have so much appreciation for its clearness and manner.
Attempts have been made to cast doubts upon the pensions position. The most conspicuous fact about the Act of last year was that it was accompanied by a big extension of pension rights. It was based upon a recognition by the Government of the extreme importance of those rights and upon the principle that, whatever else ought to be done, the pension rights of those who were going out of insurance owing to unemployment should be protected by a new extension of the Act of 1925. Every attempt to throw doubt upon that extension ought to fail and will fail. The intention of the Opposition has been to represent that the Act of 1932 was an attack upon the unemployed and was attended by a deprivation of rights. That attack will fail and it deserves to fail because it is not in accordance with the circumstances of the case. The Act of 1932 was rightly conceived, as it was described by the hon. and gallant Member for Wells (Major Muirhead), as an Act for the defence of the position of those whose interests are involved in the great system of National Health Insurance.
Let me clear away another misconception that is apt to occur. The Act of 1932 had nothing whatever to do with the national programme of economy. No economies were effected by it and the Exchequer made no saving owing to that Act. No single penny was taken out of the National Health Insurance scheme by it. The whole purpose and effect of the Act was to give solvency to a scheme which was threatened with insolvency by restoring the balance between contributions and benefits. What was the position with which the Government were confronted last year? It was that owing to prolonged depression and unemployment and the consequent failure of contribution income, the financial stability of the National Health Insurance scheme was threatened. That became perfectly clear on the third valuation report. It is completely erroneous to suggest, as has been suggested to—day, that the stability was threatened by the cut made in 1926. That cut had nothing whatever
to do with the subsequent enfeebling of the financial basis of the scheme.
Let me remind hon. Members of two circumstances in that connection. The first is that coincident with that cut the Exchequer accepted the overwhelming fresh liability in respect of the contributory pensions scheme, and brought to the support of the pensions scheme Exchequer help which amounts in the present year to £12,000,000 and which in the time that has elapsed since 1926 has enormously exceeded the £30,000,000 to which the hon. Member for Aberdare (Mr. G. Hall) referred. The cause of the enfeeblement of the Health Insurance scheme was not the cut; it was the failure of contribution income owing to the steady increase of unemployment. We were threatened with the position that if we allowed matters to go on as they were, approved societies would begin to fall into insolvency. The insurance scheme as it is organised is a chain which is no stronger than its weakest link. Each approved society stands on its own financial basis and has to be protected in the interests of the members in order to prevent the breakdown which results from insolvency of particular societies.
Immediate action had to be taken to protect the rights of insured persons. The approach to that position was recognised by the right hon. gentleman the Member for Wakefield (Mr. Greenwood), my predecessor, who dealt with the situation which was coming upon the Insurance funds. In his memoranda to approved societies issued during his term of office, he recommended remedies which seemed to him appropriate, such as more strict supervision and better certification. He foresaw the approaching storm, but the measures which he took were not adequate to restore the stability of the threatened funds. The depression continued, and the situation grew more acute until we came to the last valuation report, and that showed the immediate peril and the urgency of the need for restoring stability to the funds. I will remind the House of one figure to show the direction in which the finances of the Insurance Scheme were going. As the result of that valuation report, the additional benefits of 6,250,000 insured persons were reduced and the
additional benefits of no less than 4,250,000 insured persons ceased altogether.
There was the writing on the wall. The writing on the wall was that the surpluses of the scheme were running off, and unless measures were taken to restore its stability we should fail in our first duty to the insured. No Government with any sense of responsibility would have hesitated for a moment to take action in these circumstances. The action which was taken was in three directions. There was, first, the reduction of the benefits for women. I have heard no word of criticism of that to—day—a very striking circumstance. [HON. MEMBERS: "You will do."] The official case of the Opposition has been developed, and I think that I am right in saying that no criticism has yet been made. It was an action that is commonly felt to have been absolutely necessary for the stability of the scheme. But if such a measure is necessary to the stability of the scheme it shows the strength of the arguments that can be advanced for all measures necessary to the stability of the scheme, because that was a very much bigger reduction of benefit than any of those which have been dealt with to—day.
Two points have been advanced to—day as matters of special criticism—the loss of cash benefits owing to arrears, and the fact that persons go out of insurance altogether after a certain period, and so lose benefits. I sincerely welcome the opportunity of discussing these very important matters, and their reconsideration by this House. They deserve our most careful consideration and attention, and I should indeed be to blame if I failed to take any single measure which I could take to mitigate the position of the persons affected, consistent with the solvency of the Insurance Scheme and my general duty to the insured as a whole. What is the position as regards arrears? The House knows that from the year 1928, owing to the fact that the funds were doing well, all failures of contribution on account of unemployment were completely excused, so that the question of arrears did not really arise for the unemployed. That was done on the actuarial basis that it would cost the approved societies some £200,000 a year.
That basis was, alas, completely falsified by the growth of unemployment, and when the time came for the third valuation that anticipated burden of £200,000 had risen to 22,000,000—a crushing, am overwhelming burden, which the approved societies could not continue to bear. Therefore, they came to the Government and said: "We must have relief." The relief was given, in effect, in the form of a reversion to the pre–1928 system, and, instead of excusing all arrears due to unemployment, we excused half the arrears. The first point to notice is that this system, of which so much criticism has been made, was no new system; we were simply reverting to the state of affairs which had existed, I think, for 16 years before 1928. What was the result of that? We halved the £2,000,000 burden of the approved societies, but we still left them with a burden of £1,000,000, a burden as big as they can bear in the circumstances without being threatened with those disastrous consequences to the scheme as a whole to which I have referred. That is the present state of affairs.
Let me remind the House that very big arrangements have already been made by way of concessions in order to alleviate the position as regards arrears in respect of the unemployed. In the first place, let us get this clear, because I do not think it was made clear in some of the speeches. As long as a man remains in insurance he may draw his medical benefit and he may draw his maternity benefit in spite of a whole year of unemployment, apart from any payment of arrears at all. Let us get that clearly in our minds, because it is a very great mitigation of whatever hardships otherwise attach to arrears. Another fact which we must bring out clearly, which has not been brought out clearly in the speeches today, is that a minimum of merely 20 weeks of work and contribution will always give an insured person some cash benefit. We have had references to the period of 26 weeks, and so on, but we have not heard anything of that minimum period of 20 weeks which will give him some cash benefit.
When the Act had been passed, and when unemployment still continued, it was, of course, my duty at once to consider what could be done by administrative measures
in order to help the position for the unemployed who were getting into arrears, and measures have been taken which, within their scope, are, I think, very effective indeed for their mitigation. I will give the House a, complete account of them. I remember pointing out to the House in the Debates on the 1932 Bill that there could be a great mitigation of the loss of cash benefits through arrears if societies would use their surpluses for the purpose of excusing the arrears of their members. Earlier this year, in order to carry out something in the nature of the suggestion or undertaking which I had given to the House, I called a conference of approved societies and put this suggestion before them; indeed, I may say I urged them to make the best use they could of their surpluses for this purpose, in order to save the hardships which have been complained of to—day. I am glad to say the result of that appeal was very favourable; the societies in question made a most generous response to this call upon them to protect the unemployed against the evils referred to—a most generous response. The figures are these. As a result of that appeal, I think about half the societies and branches have actually set aside funds as an additional benefit for the purpose of additional benefit No. 17. The amount of the funds set aside is no less than £1,000,000. The extension of protection by the adoption of that suggestion is very big, much bigger than the hon. Member for Gorbals (Mr. Buchanan) realises. It covers appreciably more than one—half the whole male insured population of the country. They are thus protected against the loss of the whole of their cash benefits by arrears. In none of the societies which have adopted this system is there any unemployed member without some cash benefit.

Mr. McGOVERN: Give us the names of the societies.

Sir H. YOUNG: I said about half the societies. The amount of the relief given varies, of course, in accordance with the society and the nature of its surplus. Some have given more, some have given less; some have done very well indeed. I may mention one that has done particularly well, the National Union of Distributive and Allied Workers, with which the hon. Member for Westhoughton (Mr. R. Davies) is honourably associated. That
society has succeeded not only in paying all the arrears for its members but has actually protected them for two years.

Mr. BUCHANAN: No employment! Co-operative employes!

Sir H. YOUNG: The hon. Member criticises this relief, very practical and very effective, on the ground that the societies concerned are not the societies with most unemployment. That is true; they are not. If I divide the societies into two groups, those which have adopted this scheme and those which have not, I find that those which have adopted it have less unemployment than those which have not; but the difference between the two has been greatly exaggerated by the hon. Member. It is not the case that there is any great discrepancy between the two groups. As a matter of fact, the extent of proved unemployment in the two groups in the contribution year just ended was, on an average, seven weeks in the case of 6,300,000 entitled to benefit and nine weeks in the case of the remaining 5,100,000. The difference, therefore, is a comparatively small one, and as a matter of fact there is a very large area of unemployment which has been successfully protected by this new additional benefit.

Mr. BUCHANAN: It would be very useful if the Minister gave us the figures for one or two of the trade union societies that have given it and others that have not. He quoted what we call in the trade union world "Nudaw," the National Union of Distributive and Allied Workers, the only big union that has done it, and it is because of no unemployment that it has done it.

Sir H. YOUNG: I can give the names to any hon. Member who requires them. If you divide the number of unemployed, as between the societies that have adopted this course and the societies that have not adopted it, there is only a slightly higher rate of unemployment in the non-adopting societies over the adopting societies. I know that that is not a welcome argument to the hon. Member for Gorbals.
Now let me pass on to other measures taken in order to alleviate the hardship in this regard. Representations were made to me very early on that the real hardship was owing to the stiffness of the terms for paying up arrears. I have
taken two measures in order to deal with that. In the first place, I have made arrangements for allowing those in arrears to pay by instalments. I have issued 600,000 cards for cases in arrears and have had the possibilities of this method of payment by instalment advertised broadcast by the approved societies. The result is that as soon as anybody gets into arrear, he can at once begin to pay up. He need not wait till we come down upon him with a bludgeon for the payment of a lump sum at the end of the year. This is a very effective measure, and I hope that it will afford great relief. The second measure is one which will meet the point raised by hon. Members—an extension of the period during which arrears may be paid up. It has been represented to me that this will be a most practical way to mitigate the situation, I have, therefore, made an extension in the period of grace up to the 30th November.
Now we come to the point which has been put by the hon. and gallant Member for Wells of a further extension of the period. I have given very careful consideration to that possibility. I am conscious that this is a matter in which one can do something, and that this is probably the most practical thing that one can do to ease the existing situation. It has not been altogether easy to see what could be done as a, matter of assistance to those who are falling into arrears, but here is a practical relief which is really big, in proportion to the slight financial risk that one is taking, in view of the general situation. With the assistance of my advisers, I think that it is now possible to make arrangements for a further extension of the period of grace. I propose therefore that there shall be a further extension to the 31st March in the year following. [An HON. MEMBER: "Not enough."] I hear the words "not enough." I ask hon. Members not to adopt that attitude, because this is a further six months of grace.

Mr. LOGAN: May I ask the right hon. Gentleman how it affects the year 1934, and the period of grace?

Sir H. YOUNG: If the hon. Member will allow me to continue, I think he will see how it works out. The only difference that I am proposing is that the period of grace shall be extended for
another six months to the 31st March of the year following. [An HON. MEMBER: "Four months."] Yes, four months. That will deal with many or most of the cases of hardship which are brought to my attention by hon. Members, in respect of arrears.

Mr. LOGAN: I trust that the Minister will allow me to ask one or two questions about the very important concession that is now about to be made. Have we to give benefit to the member who is in arrears Am I to take it that the benefit is to be in suspense, or that there will be no deduction, and that the allowance will be paid until March of the following year? Will the member go on with his benefits as they are at present, without any deduction?

Sir H. YOUNG: I am sure that the hon. Member will realise the great complexity of these questions, and the difficulty of working out the details as they are at the present time. Any particular case which the hon. Member has in mind will require particular consideration.
I pass from the consideration of the question of arrears to the other matter which has been most criticised in the Debate to—day, and that is the cessation of medical benefit for those who go out of insurance owing to the failure of contributions at the end of the current year. There we were confronted with the necessity, when deciding any of these questions, that each one of us has to make up his mind whether we are to maintain this great national institution of Health Insurance or not? I think that I am not wrong in saying—I do not think I am imputing anything unfair—that hon. Members opposite do not care very much whether we maintain the insurance scheme or not. It is not a question of importance to them. To us it is a question of primary importance to maintain that marvellous instigator and strengthener of all that is good in the national character which exists in our great National Health Insurance scheme.
We were confronted with the question which, quite simply put, was: "Are we prepared, as a Government, to let the National Health Insurance scheme go the way of the National Unemployment Insurance scheme? "If we had been willing to continue people indefinitely in insurance by Exchequer contributions, long after their contributions had ceased to
entitle them to benefit, we should have brought down upon this great social service the same ruin and disaster that was brought down upon Unemployment Insurance. I think that any reasonable man will say that we were right to avoid the dolorous result of Unemployment Insurance in respect of National Health Insurance. There must be a measure of relationship between contributions and benefits. How well it was put by the President of the National Conference of Friendly Societies last month when he said: "A member has to be clear on the quarter night, or he is out of his benefit. It is part and parcel of his contract, and he has no grievance."
The hon. Member who proposed this Motion produced a certain weight of authority against the Act of 1932 and the limit put to the extension of insurance. I can produce a much greater weight of authority in its favour. Let me remind hon. Members that it is the Insurance Committees who are principally responsible for the opposition to the Act of 1932 in this regard and they are not those who come most closely into contact with the finances of National Health Insurance; those who do so took another point of view. I have a list of authorities who passed resolutions against any further extension of the insurance of those whose contributions had ceased. I will give the names. They are the National Conference of Industrial Assurance Approved Societies, the biggest of all representative associations, representing 7,000,000 insured persons; the Association of Deposit Friendly Societies; the Union of Holloway Societies; the National Federation of Dividing Societies; the Association of Catholic Friendly Societies; the Association of Works Societies, and, last but not least, the General Federation of Trade Unions.
The House will remember that a clear case was made in the debates last year to show that we have gone to, and, indeed, past the utmost limit of what is possible by way of concession to those who, owing to the misfortune of unemployment, are unable to maintain their contributions. We have stretched every possible point up to, and, indeed, as many critics would be inclined to say, beyond the limit as regards the solvency of the scheme for the maintenance of
unemployed persons in insurance. There will be 2½ years during which every man and woman in insurance will be granted free insurance after they have ceased to make any contributions to Insurance funds. There is the extension of pensions to the end of 1935 which is given to everyone, contribution or no contribution. That, frankly, is in order to allow time enough to pass for things to improve, so that, if possible, the pension rights of all who have been insured will be maintained indefinitely. The situation will be again reviewed in 1935. Then there is a certain age beyond which, if a man or woman is in insurance, they will remain insured for good, contributions or no contributions, and we have reduced that age, which under the Bill of last year was 60, to 58½, so that, if any man or woman is in insurance, on attaining the age of 58½, instead of 60 they will remain in insurance for the rest of their life, contributions or no contributions.

Mr. BUCHANAN: They are supposed to be working right up to the age of 58.

Sir H. YOUNG: Let me now come to the point regarding the hardship on those who go out of insurance this year, and at the end of this year lose their medical benefit. Let us see exactly what the hardship is. They do not lose medical treatment. At the end of the year those persons will receive precisely the same medical treatment that any unemployed person who has not been in insurance will receive. In general they will receive precisely the same medical treatment from the public assistance authorities which in many cases their own dependants have been relying upon throughout the period of unemployment. Doubts have been suggested as to whether the services will be sufficient to provide medical treatment, but it will be the duty and the task of the local authorities to see that the services are adequate, and it will be a duty which will certainly be performed by the Ministry of Health, as part of its general duty of supervision, to make sure that the local authorities do provide adequate services. As to the cost which will fall upon the local authorities, I believe it has been very much exaggerated in the course of the debate. I would remind the House, in reply to one argument which has been addressed to me, that
the Government are at this moment undertaking, in the new Unemployment Insurance Bill, a fresh liability in relief of public assistance.
What is the number of people who will be affected The Government Actuary's estimate, in his report on the 1932 Bill, was 80,000. I can give no better estimate to—day. I do not know how many persons will become voluntary contributors during the next year. Unemployment has somewhat improved since 1932, and I believe that the fears which have been expressed that that number may be largely increased are groundless. We must do all that we can to mitigate the position for those people who, if we are to maintain an insurance scheme at all, cannot be indefinitely maintained in insurance. What can we do? What is the real difficulty that has to be met? It is not that there is any real doubt as to services being available for unemployed persons who cease to be in insurance. I would remind the House that in many small districts and areas such persons will continue to be attended by precisely the same doctor who attended them when they were on the panel. In larger areas, where there are well organised public health and public assistance services at the present time, it will be possible to make use for this purpose of the staff and scientific equipment of the new public hospital organisation, which will provide very efficient services indeed. I am certainly able to say without hesitation that in those areas the services available for unemployed persons will be no worse when they come out of insurance than before.
What is to be said with regard to the particular difficulty, which has been put to me with great force by hon. Members, that the real difference will be that the insured person will cease to have his free Choice of doctor? I recognise that that is the real difficulty, and it is, if I may say so, the only practical and substantial difficulty that has been adduced to—day. Is there any way in which it can be met? There is. It is perfectly open to the local authority in a suitable case to make use of a panel system for its public assistance organisation. Experiments have been made in that direction in three areas, namely, Newcastle-upon-Tyne, East Ham and Wiltshire. I invite local autho-
rities to consider whether for this purpose in their areas a panel system may not be useful, and I assure them that, if any authority desires to make use of that system in its area for the sake of the unemployed who come out of insurance, the necessary sanction on the part of the Ministry of Health shall not be lacking.
I now arrive at the close of my examination of the position. I believe I shall have satisfied the House that it was absolutely essential for us to take the measures that were taken last year for the protection of the solvency of the National Health Insurance system. I believe also that I shall have convinced the House that every possible means by administrative measures for mitigating the situation in relation to the unemployed has been taken with activity by the Ministry of Health during the past year, including the fresh concession in the matter of the extension of the period for making good arrears to which I have referred to—day. Let me close upon a note of hope. The real remedy for the admitted evils which have been discussed to—day is in that general improvement of trade and industry and employment which will enable people to preserve themselves in National Health Insurance by their own labour and their own contributions. That is the end that we desire to see, and I am glad to say that, with a reduction of 10 per cent. in unemployment, we are already beginning to see that effect upon the National Health Insurance Scheme. I am glad to be able to say that already it is reacting on the contribution ratio, and that the fall has stopped, and I look forward with hope to the time when it may begin to go up again. The Act of 1932 was drafted in such a manner as to make it possible for the Minister of Health, as soon as the financial situation allowed of it, to restore the present diminished benefits to the condition in which they were in the years before the Act of 1932. What I can say finally is that the general improvement in the employment position makes one glad that that provision was inserted, because it is now not unthinkable that the time may come when National Health Insurance will return to such a state of solvency that we shall be able to go back to the more generous conditions existing before the Act of 1932.

1.16 p.m.

Mr. GORDON MACDONALD: The Motion that we have put on the Paper has provided the Minister with an opportunity of telling us how proud he is of his own child. He has not told us anything different from what he told us on the Second Reading of the Bill. He has given the same reasons why it was brought in. He has told us that those reasons still remain, the only alteration being that he has found during the operation of the Bill certain small items that ought to be attended to. We on this side of the House appreciate everything that has been done by the Minister to mitigate the operation of the Act. He seemed to suggest in one portion of his speech that we were not appreciating his efforts and that we were rather sorry that any of the approved societies possessed a surplus with which to help them over their difficulties. We are not sorry in any way that certain approved societies have been able to assist the unemployed. We are sorry that they are not all able to do it. We feel that that is not the best or the most effective way of dealing with the difficulty. The hon. Member for Gorbals (Mr. Buchanan) asked him to give the names of the societies. We not only desire the names of the societies, but would the Parliamentary Secretary tell us in what areas they are operating? How many are operating in South Wales, how many in Lancashire, how many on the North-East coast? How many of these societies are catering for industries that are suffering from heavy unemployment?
It is true that the society that he mentioned is a very prosperous one, for an obvious reason. It is one made up of very healthy members They have worked full time for years on end. But take societies such as I have here. Here is one in Lancashire catering for miners only. Its present membership is about 13,000, of whom nearly 5,500 are nearing the end of insurance. The reason is that it simply takes in miners. Nearly 600 have already gone out and 4,800 are due to go out on 1st January if they do not pay their arrears. Lancashire miners have had a very lean time for six or seven years. Those who have been unemployed so long that they are likely to go out of insurance at the end of the year are in very poor
circumstances, and it is impossible to find the money necessary to safeguard their insurance interests. Our complaint as regards appealing to the prosperous societies to help is not that they ought not to help, but, in doing that, the point made by the hon. Member for Gorbals is true. There are societies which have been managed as well as the prosperous societies, but which have suffered from the hard times. They have had heavy unemployment and contributions have gone down, with the result that they are in very great financial distress. We are not complaining of the efforts of the Ministry. We appreciate their efforts to deal with the difficulty, but we say that it is not a very satisfactory nor a very wise way to deal with it. Hence we put this Motion on the Paper. We are told that voluntary contribution is possible to anyone. I have friends who have taken advantage of that. They are in a position to do so. They are able to pay £7s. 6d. a year to safeguard their interests. But surely the Parliamentary Secretary need not be told that there are thousands in Norwich who could not pay the £3 7s. 6d. and will, therefore, have to go out of insurance, That is our case. This section of the population is suffering from something for which they are not responsible, and we feel that the method of dealing with their difficulties is not a wise or proper one
The Minister referred to one or two items which I want to mention also. He referred to payment by instalments. Again, I agree that that was intended to help, but I do not think it will prove very helpful. The cases that need help are the people who cannot pay either by instalment or by lump sum. Payment by instalments helps a man who is in a position to pay at all, but in our opinion it is very insignificant and ineffective contribution in dealing with the difficulty. As regards the concession that he now tells us he is prepared to offer, of a further extension, I noticed that, when pressed by my hon. friend the Member for the Scotland Division (Mr. Logan) for details he was very chary about answering. I think he realised that he was not making much of a concession, and he thought it better to let it drop quietly. We appreciate the efforts made by the Minister, but we do not think they are along the right lines, and we think our suggestion
is far better. I thought my hon. friend the Member for Aberdare (Mr. G. Hall) was being too generous when he said that he did not think the Minister realised the position. My point is not that he does not realise it but that he does not take effective measures to deal with it. I received Circular A.S. 287, and I noticed in it that he realised the difficulty, but I was rather amused at the suggestion that he put forward. He said:
In Circular A.S. 263 it was suggested that, in order to avoid unnecessary lapses from insurance, societies should inform members whose insurance is running out of their right to remain in insurance (if qualified) by becoming voluntary contributors. While some societies have adopted this suggestion and send a suitable notice to a member towards the end of his free period of insurance, it is believed that the practice of societies in this matter is not uniform. In view of the important health insurance and pensions rights involved, a lapse from insurance is a serious matter for an insured person and all societies should, therefore, make it their regular practice to send a suitable notice to members whose insurance is due to terminate.
Suitable notice of what? That they can become voluntary contributors. I do not think the lack of that notice will cause much discussion, but when they get the notice that they have not the money to pay that will cause trouble. We do not consider that to remind insured people of the voluntary contributor method is the most effective way of dealing with the difficulty.
We could go on giving cases of hardship, but it is not necessary. I am satisfied, from communications from the Ministry, that cases of hardship are well known. They know that the 1932 Act has meant hardships. They also know, in so far as they have tried to deal with them, that those hardships mean something to the insured population. The Minister puts it to us whether we believe in the insurance principle or not and suggests that the Resolution is an indication that we do not accept it. Let me say at once that we do accept the insurance principle. We say that the variation of the State contribution is not a violation of that principle. It was varied in the past, and no one then suggested that it was a violation of the principle of insurance. When it was varied in the interests of the Chancellor of the Exchequer it was not asserted that it violated in any way
the principle of insurance, and we say that to ask for an increase in the State contribution at this time is certainly not a violation of the principle of insurance.
We on this side of the House are very anxious to see the Fund solvent. We realise that the interests of men and women in this country depend upon the solvency of the Fund. Surely it does not mean that because we suggest that the State should help to keep it solvent, we are not concerned about the solvency of the Fund. We are anxious about the solvency of the Fund, but our point is that as a result of grave unemployment a position has been created in which solvency is impossible if the present arrangement is to continue only at the expense of insured members themselves. Solvency must be secured along proper lines. It is far wiser and more human and defensible to secure solvency by an increased State contribution than by sacrificing the interests of this section of the insured population. That is our case. Members on the other side of the House may disagree. They may say that they think that the insured population ought to bear the greatest part of the burden. We on this side of the House simply say that the Act of 1932 was supposed to solve the burden of a certain section of the insured population in order to maintain solvency. Solvency we accept, but we do not accept solvency by this method. Our only reason for putting the Motion upon the Order Paper is to make the position clear to the House in the hope that the House will realise that the nation as a whole is far more capable of carrying the burden of the solvency of the Insurance Fund than a very small unfortunate section of the insured population.
After all, what is the difference between those on this side of the House and hon. Members opposite? It is obvious that the difference is not upon the question of the principle of insurance. The difference is as to how the unemployed ought to be treated. The Minister, in so far as he gave a forecast of legislation on Unemployment Insurance, stated that it would take off some burden in regard to the cost of public assistance. If we are to discuss that matter in this debate, I can assure the Parliamentary Secretary that we are not very much encouraged by the fore-
casted legislation. We do not see much love there for the unemployed, nor do we think that this problem ought to be dealt with along those lines. The difference between the Government and the Opposition on the question of the unemployed persons is that the Government have come to a decision that the unemployed shall maintain themselves, or be maintained by their immediate relatives, whereas we on this side of the House have always said, arid we say it to—day, that unemployment is a State responsibility. When a person has been unemployed for a long or a short period, whether in sickness or in health, we say that it is the responsibiliy of the State to see to it that his health arid position are safeguarded by an increased contribution from the State. I do not see how a Government who accept a variation of the State contribution downwards in regard to Health Insurance when it suits them can possibly suggest that a variation upwards in the interests of the insured population is objectionable. We feel that if this Motion is not carried any attempt on the lines laid down by the Minister will fail to deal with the situation effectively and as it ought to be dealt with.

1.29 p.m.

Mr. CLARRY: I do not propose to follow the last speaker in any detail as to how remedies should be effected in the impasse at which we arrived this morning, or to enter into any detail of administration which we have heard from previous speakers, but rather to look at the matter for a few moments from an entirely broad aspect. I listened with great attention to the statement of the Minister just now in the hope that I should be able to find some worthy justification for the steps contemplated in the forthcoming arrangements and regulations. I accept, of course, with gratitude the small mercy which he showed by extending the date, and, if I read it rightly or understood it correctly, the position was that in the stressful circumstances and the national crisis of 1932 a certain Act was undertaken, with certain regulations, in order to put the Health Insurance Act upon a financially stable basis when there were a large number of unemployed and when our financial position was not as definitely assured as it is to—day. The House then agreed to measures which would safe-
guard the Acts under the extraordinary conditions and difficult circumstances which were then arising. Arrears can only be met by cash by the unemployed man, and how an unemployed man is to find cash to make up arrears in order to qualify for benefit I cannot say, but the concession now granted by the Minister is that a large number of unemployed persons instead of running off medical benefit on 1st December will run off benefit on 31st March of next year.

Mr. LOGAN: Tie does not say so.

Mr. G. MACDONALD: He refused to say so.

Mr. LOGAN: He could not say so.

Mr. CLARRY: I am only putting it to my right hon. Friend that my reading of the position—and I should be glad to have his view upon it—is that unless they are able to pay up arrears between now and the further date of 31st March they will run off medical benefit. I speak from some experience in my constituency where there are a vast number of unemployed persons, and although there may be—I certainly hope so—a number of them put back into work between now and the 31st March, it will be a very small proportion, and a large number of deserving men who have already suffered considerably by trying to find work will have the further ignominy of being taken off medical benefit. It is only a question of postponing the evil day by four months. That is the position as I read it to—day. When they are no longer able to avail themselves of the shelter of Health Insurance and medical benefits and some of those other benefits, they will then be forced on to the Poor Law and the public assistance committee, and upon local hospitals and charitable institutions.
I have not heard anyone mention anything about the effect of further straining the resources of and burdening public assistance committees and local rates. That matter was ventilated and dealt with by a special grant earlier this Session, but the result can only amount to this. If these men are unemployed persons who have run off Health Insurance benefit and they fall sick and have to go upon the rates in one way or another, it will only increase the already over-burdened rates in the distressed areas. It will make it more difficult for
work to be found in the particular areas where there are the most unemployed. The voluntary institutions and hospitals are already feeling the strain, and it will only make the situation more difficult in that direction. If these persons cannot get the same medical attention—this is on the assumption that they will run off medical benefit on 31st March—after that date their health will obviously deteriorate and be seriously impaired. As a nation we cannot afford to allow them to remain idly by. There is, moreover, the question of adopting a humane attitude in regard to adding to the distress —and I mean mental distress in this case —of unemployed persons who find the advantages of medical benefits taken away from them through no fault of their own. They are at the present time endeavouring to live and to eke out an existence on what we all admit—and it is all we can afford at the moment—are the inadequate unemployment allowances which they receive from one source or another. I do not necessarily blame the Government for this. There is no blame attaching to them, but this is a national matter, in which we are all interested, and I do not think that the country can afford to forsake these people. There is a moral liability. Do not let us forget that when the Health Insurance scheme came in the workers were forced to join the scheme and abandon some other scheme, and they were given no option to contract out. There is, therefore, a distinct liability to keep faith with them on moral grounds, although it may not be on financial grounds.
I listened to find any arguments that would justify allowing this situation to arise, and I can find only one in the question of financial stability—financial stability in the Health Insurance scheme, while admittedly there will be financial instability in other directions, namely, the public assistance committees. It is a case of refusing to take the money out of one pocket and taking it out of another. While I am in favour of the financial stability of the Health Insurance scheme being maintained. I realise that we can only force sacrifice where there is a definite urgency and necessity. There was an urgency in 1931, because there was a financial crisis, but there is no financial crisis to—day. The same urge for economy, or alleged economy, does
not exist to—day as it did in 1931, and certainly not in 1932.
I should like the Parliamentary Secretary to state the amount of money that is going to be saved—I query the word "saved," because it is not actually going to be saved—to the insurance scheme by allowing unemployed persons to run out of medical benefit, whether on the 1st December or on the 31st March. That saving would have to be vastly big to be worth the enormous risk we are taking in regard to the health and morale of our countrymen to—day if we allow them, to run out of medical benefit. It may be that to continue to grant these medical benefits at the present time would be financially uneconomic, but it would be economically sound to continue them. If the extension to the 31st March is merely a concession, taking it in easy stages, and before that date arrives there will be another three months or six months' grace allowed, I accept it with gratitude, and I hope that that will be done. I do appeal to the Minister to weigh the pros and cons of the situation very carefully. There is a great deal more in the matter than transpires at the moment. It would be worth while if we could be given an assurance that the small concession already given is one that will be viewed sympathetically in connection with the other dates as they arise.

1.39 p.m.

Mr. RICHARD EVANS: The ground has been traversed and practically everything that can be said has been said, and I would not have arisen except for the fact that the reply of the Minister has left so many matters in the air. I would ask the Parliamentary Secretary not to leave the situation as it has been left by the Ministry of Health. A perfectly straight question was put to the Minister by the hon. Member for the Scotland Division of Liverpool (Mr. Logan), and the Minister, with a conciliatory gesture, said: "We recognise that there is a grievance, and I will make a concession." Then—I say this with great respect—he rather mumbled something about March. What exactly is the significance of that? Will the people whose benefit will lapse at the end of November be safe for full benefits until the end of March, or does the concession mean that their benefit will lapse at the end of November and that if they can arrange with the ap-
proved society, or if they can contrive to beg, borrow or steal 18s., or whatever the sum may be, they will become entitled to benefit at the end of March? It is a perfectly straight question and I would like an answer. This is a matter of grave interest in 80,000, or it may be 100,000 homes, and it should not be left so indefinite.
The Minister has told us that he was very anxious that the insurance principle should be maintained. Naturally, he wants the solvency of the societies to be secured. We all agree with him there. But are you in any way jeopardising the principle of insurance by modifying the State grant? Under the Economy Act the State grant was reduced by £2,000,000. Was not that jeopardising the principle of actual soundness? Therefore, we have a right to ask that a subsidy should be made to keep these people in benefit. If this question was so widespread in its application and involved a very large sum, a strong case might be made for modification, because the solvency of the Fund will have to be maintained. It is a situation which affects certain areas very acutely. Take the situation in South Wales. We rejoice in the statement of the Minister, who is an undoubted authority, that his outlook for the economic future is one of optimism, but the fact remains that in South Wales, while the newspapers were eulogising the Government for what they had done and that the unemployment figures were better, they were actually worse in the last return for South Wales. The areas which have felt the full blast of economic depression are those that are going to be penalised, and those public assistance committees which are weighed down with the cost of keeping their poor are to have an additional burden put upon them.
Can we have this matter cleared up? Will the Parliamentary Secretary tell us exactly what is involved in the concession of the Minister, and will he also tell us whether you are in any way impairing or jeopardising the principle of insurance by making grants which will keep these people in benefit. I agree with the hon. Member for Newport (Mr. Clarry) that this is not merely a financial issue. People have grown up with insurance, and they have a great regard for their insurance
rights. They are part of our social system and have come to be regarded as the symbols of the acceptance by society of responsibility for them in their sickness and old age. It would be a moral tragedy if these people were thrown on to the public assistance committees, and their pauperisation which will follow from the Unemployment Insurance Bill, when it becomes law, will be made worse. We have a right to a certain amount of lucidity and clarity in this matter, and my vote will be determined by the answer of the Parliamentary Secretary. It is not too much to ask that we should know where we stand, and that anxiety shall be removed from some thousands of homes during the week-end.

1.47 p.m.

Mr. LOGAN: I was rather amused by the Minister when he spoke of concessions. It shows that the Minister of Health does not know anything at all about the National Health Insurance Act. The right hon. Gentleman thought that a longer period should be allowed, until the end of March. The Act deals definitely with the matter. It is not within the option of the Minister to turn round and nod his head and say, "We will come to an agreement ". I know that the Minister has power by regulation, but have we had any statement that he intends to do anything of the kind by regulation? The only method by which the Minister of Health can do anything is by the issue of a regulation. The position is quite clear. For the first time the Act of 1932 is about to make a transformation and throw at least 80,000 to 100,000 people into the hands of the Poor Law. These people to—day are insured persons. I have been connected with all National Health Insurance since its inception and I claim to know as much about it as anybody in the insurance world. I want to point out one or two defects. This scheme was brought into operation in order to give protection to insured persons. Up to a point, so far as health services are concerned, it has been ably managed by the officials of the Civil Service, and I must bear my testimony to the fact that from 1912 they have administered it grandly.
Our point of difference is not with the administration of the Civil Service but in regard to legislation. The Minister of Health does not understand the
psychology of 1933 and the crisis through which we are passing, which is causing what he terms economies to be brought into operation. We on this side of the House say that they are not beneficial at all to the nation. The Minister says that the only question of any important raised to—day is the question of the transference from the panel doctor, and he went on to say that he does not see that it will make any difference because in small localities the panel doctor will he the parish doctor. In the case of bigger communities he had a brain spasm. He thought it was quite possible, I suppose it is probable now—and he proposes to send an instruction—that owing to the great influx of panel patients who will come on to the Poor Law the municipalities will be able to make arrangements for panel doctors to attend not only panel patients but poor law patients as well. I think he is going far beyond the mark. He will upset local government; and I think he is going outside the Act of Parliament which deals with insured persons.
The prolongation of insurance was one of the measures consistently advocated by the Labour party, but it must be patent to the country that the National Government in its scheme of economy has at last made up its mind, whatever the Labour party did to keep the unemployed in full benefit, to deny at the end of December, 1933, not only additional benefits, but all benefits to insured persons who have not kept up their contributions. I agree that there is protection in the Act for old age and for those who have been continuously employed for 10 years, but if a man has been in an approved society for eight or nine years and is three years and nine months in arrears he is automatically thrown out. Although they may have contributed they are not going to get any benefit unless under the Act they can again become employed. That may be all right from an actuarial standpoint, but when we come to deal with social problems it is a different matter entirely. Those who are regularly employed will never feel any hardship. The social service, brought into operation in 1912, was not to deal with the man with 52 weeks employment, or with 50 weeks employment, but to cover the whole of the insured persons, totalling to—day about 16,000,000. If that be so, then surely it should be within the bounds of possibility
to keep National Health Insurance solvent and find some method for providing the insured persons with further benefits.
We have heard to—day that we are to fight against the 1932 Act. It says that on the 2nd July insured persons shall get an arrears card showing how they stand, and that on the 30th November, the latest date for arrears to be sent in, the society on and after that date will fix the deductions which must take place the following year. When the Minister tells us that he is prepared to make a concession up to March and there is nothing in the Act concerning it, I am wondering what he is talking about. There is nothing in the Act which says the Minister can make rosy promises. There is nothing tangible in the suggestion of concessions, and nothing concrete in the remarks of the Minister. There is nothing in the Act which gives him this power. He has used all the power he has to bring these enactments in. What is the good of his promises if there is nothing in the Act which gives him the power to make promises. He made this remarkable statement, that if a person pays 20 contributions he will get some benefit. If they pay 20 contributions, what is the benefit they are to get? Under the Act, and under the scheme that is to be brought into operation, they will get no sickness benefit and no maternity benefit, hut only the additional benefit. They will get medical service which they would get without being insured members of any society. They can get it now under the Poor Law. It is no use the Minister, when talking of solvency, to get up and state that a person can get a benefit which is not a benefit under the Act at all. The benefit, of a panel doctor—yes, at the cost of the society, which will have to pay 8s. 6d. per annum. I am not anxious that the approved society should bear the cost.
The position as to arrears has been wrongly stated to—day. I will give some figures, and if the Minister thinks they are wrong he can contradict them. It appears that under the arrears system that is to become operative on 30th November, if any person has had contributions credited only up to 39 weeks that person will not be able to receive various cash benefits; he will be able to get medical benefit but will not be able to get the ordinary benefits in cash. For 25 contributions they will not get maternity
benefit at all. As to arrears, if I understand the circular correctly, under the Act 50 contributions will have to be paid. In the case of 38 contributions there would be 12 arrears. Any Secretary sending out an arrears notice in July or August to be returned on 30th November would include an arrears card showing that for 38 contributions there were 12 arrears, and those 12 arrears would be 12 at is. 6d. That is say 18s. would have to be paid for receipt of benefit. Then take the case of 39 contributions. That would leave 11 arrears. But those 11 arrears would pay only at the 9d. rate. Between 39 and 38 there is, of course, a difference of only one. Any Society of dockers or mercantile marine men or of workers in a factory would be faced with this position: One person has 38 contributions, and the arrears would represent the payment of 18s. Another person has 39 contributions and the 11 arrears represent only 8s. 3d. Those figures cannot be disputed. The one payment is out of all proportion to the other.
Instead of making rosy promises which cannot be fulfilled the Minister ought to have a graduated scale on the lines of what we have had in previous years. Members of an approved society who for the past three half years have been unfortunately unemployed will have franked cards stamped at the employment exchanges, or they can bring alternative evidence which is equivalent to the franked card. If they bring three half year's cards not franked, at the end of 1933, unless they have been ten years employed, they go out of insurance absolutely. They have to find employment again and to get eight working weeks paid to their credit before they can be considered. Yesterday I asked the Minister a question with which he said he would deal to—day, but he has not dealt with it. It was as to the appointment of medical officers to take the place of the displaced panel doctors. The right hon. Gentleman said the question would have to be considered by the local authorities.
On the figures of the Minister 18,000 people will be definitely thrown out on 31st December next. But they are only a small proportion of the total. In my opinion of at least 3,000,000 under the Act most will get no benefit whatever next
year. Every person who has not contributed under your scheme will go out by 31st December, 1933, according to the different specified periods that you have arranged. Then you have to take into consideration the fact that the penalty year not having expired for those who have contributed portion, they will be penalised. Those not able to pay the 18s will, for the purposes of the Act, have a reduction for the whole insurance year of 1934 Against them. I contend that with employment as it is to—day only a lucky man or woman in any of the casual trades will be able to come along with a card stamped for more than 35 working weeks in the year. I know and the Minister must know the conditions which are caused by the rise and fall of trade in this country in occupations connected with shipping and the docks and warehouses and so on. As I say, he will be a very fortunate man indeed who will have 35 contributions to his credit in these trades and the remarkable thing is that the man working the:35 weeks is going to suffer penalisation in 1934.
Is the Minister only dealing with actuarial figures or is he dealing with a social plague? Is the solvency of the Fund to be the only factor which is to count in dealing with this subject? The Minister boasted to—day that he had sent out a circular to many approved societies asking them to adopt a new additional benefit, and that they had responded wonderfully well. Does not the Minister know that that is soft soap kind of talk? It is only wasted in the House of Commons on men who know and to those who do not know it is. as I say, only soft soap. It is not a true statement of the case at all. No society can give such a benefit unless they have approved funds—unless they have additional funds at their disposal over and above the actuarial valuation. When it comes to societies whose members can only have 35 stamps on their cards the Minister will not be able to find in those societies an amount of money available to give this additional benefit.
The Minister said that nothing constructive had been brought forward. He has never asked for any constructive ideas. The National Government seemed to think that constructive suggestions mean only economy and efficiency. Have they ever thought of an all-in system of in-
surance? Do they expect the casual worker with 30 or 32 stamps a year to keep solvent in days of poverty and depression. Is it not time that you brought in your civil servants with pensions and your large bodies of policemen who are well protected and have good wages and pensions into a national scheme with reconstructed policy, so that you could keep the scheme solvent and give additional benefits to every society? If you want to have a national system you cannot give exemption to particular classes as you do under this Act. You cannot exclude from it those who are well-to-do and in regular employment. Surely the big approved societies have a right to ask for the protection of the Government and that they should be given "good lives." It will not affect the society to which I belong, but it will affect the administration of many of the large societies by giving them funds so that they will he able to grant additional benefits.
No Government Department could carry on this work as the approved societies are doing. The nation is getting this work done by them very efficiently and at a very cheap rate, but by your regulations and the circulars which you are sending out on the basis of economy you are handicapping the societies and putting upon them an onerous burden which they ought not to be called upon to bear. I contend, from the national health point of view, that in what the Government are doing, firstly there is no efficiency, and, secondly, it is detrimental to the best interests of the nation. You will in the end by these methods place the burden on the depressed areas to a greater extent than ever. You will dislocate the national service of doctors. You will do injury to the insured member. I do not want to curse, but it is enough to make a saint swear. Your system of charges in connection with the question of arrears is entirely out of proportion.
On the question of reconstruction, seeing that the Minister of Labour has now brought in a Bill dealing with labour and insurance, may I ask if in the matter of National Health Insurance we are going to come up to date with the regulations contained in the new Bill? Is it possible to give an accretion of money to the insurance societies by bringing lads under the aegis of National Health Insurance immediately they leave school? When
those who have statutory exemption at present are brought in there will be a means of obtaining the money without any reduction to the unemployed. If you bring the schoolboy and the schoolgirl into the National Health scheme at the school-leaving age you will have solved one of the greatest difficulties with which we have had to deal in connection with child labour. The question of benefit can easily be arranged. They can go on a probationary period. My contention is that every child that is working ought to be insured, and those insurance contributions would go to relieve the situation from the actuarial point of view.
I am not satisfied that the Government have done the right thing. I am administering this Act, and I defy any Minister to say that by the course which is being followed you are easing burdens in regard to the poor. On the contrary, you are denying them a right for which they were insured, and, on top of the poverty and depression of the last three years, in the name of economy you are penalising them still further. Your actuarial figures are correct, but your attitude as indicated in the Act of 1932 is most inhumane. A change is required, and when the men and women of England realise in 1933 that they can no longer receive benefits which they have been receiving for some years past the question of national solvency will not concern them very much. The mentality of a National Tory Government will concern them a great deal more and hon. Members opposite will have to answer for it at the next Election.

2.13 p.m.

Sir RICHARD MELLER: I have listened very carefully to the argument put forward in support of this Motion, and, frankly, I have been unable to follow most of the arguments used by the last speaker. I have every consideration for the sympathy which he expressed with those unfortunate people who may be removed from benefit by reason of unemployment, but I find it difficult to agree with practically anything he said, except the one sentence which expressed appreciation of the position of the approved societies and the great work of National Health Insurance. I would have expected the hon. Member to take that line as he claims to be an administrator——

Mr. LOGAN: I did not take that line.

Sir R. MELLER: The hon. Member said that, but for the work of the approved societies, the scheme would have cost a great deal more, and there would probably have been a greater deficiency than has been found. Indeed, he lauded the whole system of the approved societies to the skies. With that I am in agreement, because I think to—day the real question which this House has got to consider is whether it would advise the Government and the nation to depart from the accepted administration of National Health Insurance and to adopt a form which would not be insurance at all, but a question of treating the individuals who fall by the way by means of State subsidies. The proposal here is that you should throw upon Health Insurance funds a burden which they are unable to bear unless you are going to provide a number of societies with State subsidies.
This scheme is one which is worked by 7,500 societies, and as soon as you start to tamper with the solvency of those societies, the effect of the individual societies brought to a state of insolvency would be to bring the whole scheme toppling to the ground. There was held a meeting in which there was a deep and proper appreciation of what had been achieved, not by going to the Government for subsidies, not by following the line followed by unemployment insurance, but by sticking strictly to the principle of endeavouring to make the benefits within the scheme itself. I venture to say that if you depart from the principle of insurance, that is, giving the benefit according to the premium which is paid, you are going to wreck this scheme, which has proved itself not only efficient but very economical in its working. Consider what has been done to assist the people in the different periods that this country has gone through since 1912. It emerged safely from the period 1914–1918, and from the period which followed the boom after the War, and the great period of stress and unemployment which still exists. To be able to come before this House and say that this is a solvent scheme and a strictly insurance scheme, is something of which this House and country may be proud. It would be a fatal, certainly an unbusinesslike, thing if we were to depart from that principle.
What is the question behind this Motion to—day? It is that there are a number of persons, fortunately, as I believe, fewer at the end of this year than would have been the case last year, who may pass out of the benefits of insurance. But we have to remember that thousands of persons during the past 21 years have been enabled to receive benefits greater than those promised in the original scheme, and greater than could be reasonably expected, and not one penny of extra money has come from the State by way of subsidy. It might be said: how has this been attained? Has the scheme itself been overburdened by contributions, or what is it that has tended to this successful administration? Let me say that sacrifice has been made by the societies themselves; in fact, a sacrifice has been made by members who have foregone benefits which they might rightly have claimed, according to the authors of this scheme. The additional benefits, which might have been provided for the fortunate people remaining in insurance, have been given up and transferred for the benefit of the less fortunate members.
What has been done by the societies during the past year to meet the question of arrears? It has been said that many of the societies who are in the fortunate position of being able to do so have devoted a portion of the amount which bad been set aside for additional benefits towards the support of a new additional benefit called No. 17—an additional benefit for distress. That was not brought. from some unknown source in the societies' cupboards. That was not something suddenly found for them. It was actually a denial of benefit by certain members who, if they had been selfish might have said, "We can do with additional benefits."

Mr. LOGAN: Or re-allocation.

Sir R. MELLER: My hon. Friend says "re-allocation," but if members had resisted there could have been no alteration of the scheme of additional benefits during the periods originally agreed. Let me take another point. It is said that by the Economy Act, and the various Measures which have been brought forward, particularly the Act of 1932, the Government themselves profited by the scheme which had been introduced. What
has been the result of the societies prior to 1932 taking upon themselves the burden with regard to unemployment? We were told when the last Bill was going through the House that the societies felt they could no longer bear the burden of £2,000,000 a year. It was, therefore, proposed that there should be a rearrangement whereby the societies' burden should be limited to £1,000,000. But do not let us forget what that meant. By remitting the contribution of members, and by the societies accepting that burden of £2,000,000, subsequently reduced to £1,000,000, many thousands of persons have been brought into benefit, and inasmuch as the State comes in with the societies with a contribution in respect of the benefits paid, but for that generosity the State would have been burdened with a greater payment than it might otherwise have had. to meet.
Do not let us be ungrateful for what the State has done in this respect. If we were to admit the principle of subsidising State insurance we should remove at once what my hon. Friend the Member for the Scotland Division of Liverpool (Mr. Logan) regards as a great advantage, that is, administration by the approved societies, and we should at once make this great scheme nothing but the sport of politics—a dangerous thing to introduce. I have as much sympathy, although, unfortunately, I cannot express it with that depth of feeling that my hon. Friend the Member for Gorbals (Mr. Buchanan) applied, for those who are removed from Health Insurance. I appreciate as much as he does how much every decent-minded man would prefer to take his benefits according to his insurance, and according to the contributions which he has paid, in preference to having to go and state his case and ask for assistance. But when we are getting into this realm of sentimentality do not let us forget real things. Do not let us forget that vast body of persons who have not had the benefit of Health Insurance. Let us remember, also, that among those who to—day would be glad if they could have unemployment insurance and the benefits of sickness insurance, who, in the past, have contributed by taxes to the support of that portion of Health Insurance which is the State's contribution, have to—day no opportunity, no alternative but themselves to seek relief
by way of the public assistance committee. Do not let us give way on this question of sentiment. [Interruption.] Thank God we have such an institution in this country that no man can say that lie must starve. I believe, and I have some opportunity of knowing, that the public assistance committees of this country do administer in a human and sympathetic spirit. Whatever hon. Members may say with regard to the public assistance committees, what difference can there be between a grant given by way of subsidy under an insurance scheme and a grant which is administered by a body which is called a public assistance committee?
The real question which is being put forward to—day is this: What can be done with regard to those persons who at the end of this year will fall out of their last benefit, namely, medical benefit? So far as the Health Insurance scheme is concerned, they have done all that they can do for them, and it would be wrong and improper to impose upon the Health Insurance scheme a burden which it ought not to bear and which is properly borne by the public assistance committees of this country. I say, with regard to those persons, that you have no right to throw a further burden upon the insurance scheme. If you were forcing these unfortunate people for the first time in their lives to go to public assistance, you might then have a stronger case, but let us consider the position fairly. The individual who has lost his rights under health insurance, namely, for cash benefits, has probably been for many a week in the position that he has had to seek the assistance of the public authority. The medical service which lion. Members say, and I agree, is a very desirable thing and a very valuable right for him to have, does not extend to wife and dependents. My hon. Friend pointed out quite early that that was part of the scheme contemplated by the authors and those who entered into this scheme of health insurance, that there was going to be a much wider definition of medical benefit than unfortunately has been obtained by insured people. so far, but let us remember that the wife and the children of a man who has not been in a position to afford medical treatment by private means have been forced to go to public assistance.
If there be something undesirable in the medical system under public assistance authorities, we should have heard something of it. It has been rightly pointed out that the same men in many districts who act as medical officers for the public authority are also acting as medical practitioners under the insurance scheme, and I have too much respect for the medical men of this country to believe that there is going to be a differentiation of treatment because, on the one hand, the patient is a panel patient and, on the other, has come via the public assistance committee. The Minister has promised that there will be adequate medical treatment available throughout the country, and he has said something further, which, I think, ought to hearten those who have been persuaded to disparage the medical service as administered by the public health authorities, namely, that it is possible for arrangements to be made with panel practitioners throughout the country so that personal service, with choice, which may perhaps be limited, and with that confidence which comes from having service which is on the private side as opposed to the public, may be available. Those of us who have read our papers will have seen that a meeting was held yesterday in connection with medical service in Kent, and that a proposal was there made that there should be a widening of the private practice of the medical insurance practitioner, that we. should have in private practice to—day a real public service such as was contemplated as an ideal medical scheme under health insurance.
I think this House will be wise to maintain, as it has maintained, the insurance principle of this scheme. Indeed, I should be surprised if, within a few weeks from now, we do not bring the unemployment insurance scheme back into the position in which it ought to have been maintained from its very commencement. It is by allowing unemployment to depart from the principles of insurance, by gradually yielding from time to time to the pressure for further payments, that unemployment insurance has found itself in the position in which it was prior to the beginning of this year. I look forward to an improvement in the employment conditions of this country. I regard the sacrifices which have been
made by the approved societies as being as far as they can go consistent with the solvency of the fund. I should regard any departure from the insurance scheme as bad, not only from the point of view of the insured persons, but from the point of view also of the country, and because of this and the assurances given in the adequate answer provided by the Minister of Health, I shall certainly vote against the Motion which is before the House to—day.

2.32 p.m.

Mr. BANFIELD: I am afraid that the speech to which we have just listened is not likely to bring any real hope or any help whatever to the 80,000, or more likely 120,000, persons who are to be cut off National Health Insurance benefit. We have not disputed here to—day the principles of insurance so far as National Health Insurance is concerned, and we are not attempting to make the societies less solvent, but we are asking in this Motion that a Government grant shall be made, a comparatively small addition to the grant already made, to enable unemployed persons to be kept within the realm of National Health Insurance. The Minister has made us a very small concession, but I have very grave doubts as to whether in actual practice it will amount to any concession at all. He suggested that the period during which unemployed persons or persons in arrears may pay their own contributions might be extended, but I am satisfied that the position of unemployed persons is such that they are in no position whatever to pay these contributions; and I want again to draw the Minister's attention to the fact that even when they may have made sacrifices to pay, there is no guarantee that they are going to receive any benefit.
In a question that I asked the Minister on this matter some months ago, I pointed out to him that there are many cases of contributions made which will not entitle the persons concerned to health benefit, on account of their not having been employed for a considerable time in an insurable occupation, and I can imagine nothing worse than the position of an unemployed man and his family, who might have made great sacrifices to pay the 18s. which they thought would put them into benefit, and have then found that, having made the sacrifices, as a matter of fact there would be
no benefit at all. Further, I am satisfied that if these people go out of insurance, as presumably they are, the only effect will be to throw the burden upon the local authorities. In the vast majority of these cases, which may in the aggregate amount to nearly 250,000 these people would be entitled to pensions at the age of 65. They will not get a pension at that age and they will have to go on to the Poor Law. Then there is the fact that they are out of Health Insurance benefit. If a man is ill he must have extra nourishment and something to live on, and that expense again will fall upon the local authorities. Many of them will complain bitterly about the added burdens placed upon them.
I made the point in the discussions upon the 1932 Act that there is nothing more calculated to cause a sense of discontent and unfairness than the fact that certain persons will be entitled to pension rights and other persons will not be so entitled. The hon. Member for Mitcham (Sir R. Meller) can talk about the generosity of approved societies and the Minister can talk about the generosity of the Government, but the common people will be entirely unable to understand how they have lost their pension rights and their sickness benefit rights. They will believe in some way or other that they have been wrongfully done out of them. We have heard a great deal about the financial stability of approved societies. It has been said over and over again that we must keep the financial stability of the societies intact. I notice that the Minister said that the societies are only as strong as their weakest link. Then the hon. Member for Mitcham, after paying a glowing tribute to the approved societies—and, incidentally, I can tell him I am connected with one—said that it is necessary that their financial stability should be assured.
I want to put to the Minister a point which will have to be dealt with sooner or later. Everyone pays the same amount of money into National Health Insurance, but what kind of system is it that enables certain people to draw far more in benefit than other people? Is it a fair system? Should it be allowed much longer that, because of the incidence of unemployment and sickness in one particular trade or industry you get weak approved
societies whose surpluses are scarcely visible? Then we get legislation of this kind, not necessarily to protect the interests of the flourishing societies at all, but simply to bolster up societies which are weak through no fault of their own. The hon. Member for Mitcham has provided the figure of 7,500 approved societies administering National Health Insurance. Surely when it comes to a question of reorganisation, it might well be considered whether it is necessary to have 7,500 societies with 7,500 secretaries, 7,500 staffs, and 7,500 committees of management. Why cannot the whole system be brought under one head and a State medical service instituted That would deal with the matter and enable the surpluses now lying to the credit of the societies to solve this question of the unemployed man.

Sir R. MELLER: Would the group with which the hon. Member is connected be prepared to support him in bringing forward a scheme for one national society?

Mr. BANFIELD: I am not in a position to speak for any group, but I am in a position to speak for my own society, and the answer is that we are prepared to recognise, as we have always recognised, that the present system is wasteful, that it leads to tremendous expenditure, and that, in spite of the hon. Member's statement that the societies are administered cheaply and economically, the fact remains that on the one hand we have societies with large surpluses, and on the other hand societies with no surpluses at all. It is neither fair nor just, seeing that everyone pays the same rate of contribution, that some people should be able to secure better benefits, not because of any special virtue in themselves, but because of the special occupation which they might be following.
I want to make an appeal to the Minister, although I am not very hopeful of the result of an appeal on this matter. I want to point out to him the position of the unemployed person who is now to be put out of National Health Insurance altogether. In spite of the improvement in employment of which we hear so much, I am satisfied that the position of the men over 50 years of age, who have been unemployed for two or three years and in many cases more, is that they will not get back into employment at all. I con-
sider, in spite of the Minister's statement, that this is an attack upon the unemployed man. It is easy to say how sorry you are for the unemployed man, but the fact remains that he is being punished all the time solely because he is unemployed. As a matter of fact, the punishment is greater than he should be called upon to bear, and I hope that as the result of this Debate something may yet be done to enable the unemployed man to be retained in National Health Insurance. I am satisfied that the money is still in the scheme, that the basis of the scheme is still sound, and that ways and means can be found to redress what will be an intolerable injustice to the men who have already suffered so much, who are suffering still, and who are being asked to suffer still more as a consequence of the 1932 Act.

2.44 p.m.

Mr. McKEAG: I would not have ventured to intervene were it not for the fact that in the Debate on unemployment on the 12th April this year I made an urgent appeal to the Minister in connection with this matter. I would remind the Minister of the instances I then gave. I cited the case of a man of 55 who has been insured for, say, 21 years. He has had as family doctor a panel doctor for the whole of that time. Having been unemployed for two years and nine months at the 31st December of this year he will lose the right to be attended by his family doctor, and will have to be attended by a Poor Law doctor, being placed in the hands of some medical man who is entirely unacquainted with his medical history. The other instance I gave was of a man unemployed and uninsured at the age of 65 who will lose his right to medical benefit for the rest of his life, except under the Poor Law. I would take this opportunity again to urge upon the attention of the Minister the instance I have cited, and would add my voice to the appeal already made by the hon. Member for Mitcham (Sir R. Meller) that a man who comes under the new provisions outlined by the Minister shall be entitled to be attended by his own medical man, instead of being put under the care of someone who has no knowledge of his medical history.

2.47 p.m.

Mr. McGOVERN: The speech of the hon. Member for Mitcham (Sir R. Meller), who has now left the House, was such a one as might be delivered to the directors of the Prudential Insurance Company, of whose approved society he is the president. It was in the nature of a lecture to a thrift society or a company of directors to show exactly what ought to be done with the finances in the interest of those who might be compelled to bear additional taxation to meet the present situation. The Minister of Health stated that the Act passed in 1932 had no connection with the economies which had been previously recommended. I most seriously disagree with that statement, because I find the measure is in accord with the general economies recommended by the May Committee previous to the break up of the Labour Government. When considering National Health Insurance they stated periodically in their review of the situation that they were perturbed at the expenditure and the drift of the scheme towards insolvency. They recommended a cut in the amount paid to the doctors for attendance on patients under the scheme, and if we look at page 158 we find that they say, dealing with the National Health Insurance Act of 1928
These arrangements are so generous to prolonged unemployment that we can see no adequate ground for the extension of the Prolongation of Insurance Act beyond this year in so far as it concerns health insurance.
On the maternity question and the pensions question they also give a broad hint to the Government, in paragraphs which I do not intend to delay the House by reading, that it is essential to devise some scheme of economy. Therefore, the statement of the Minister of Health was not strictly accurate; to put it bluntly, it was untrue to state that the Act was not a, part of the general policy of economy recommended by the May Committee. The two things cannot be divorced. I have listened also to various speeches made from the point of view of approved societies. There has been a general desire to explain why the approved societies should be kept in a solvent state. One may desire to see an insurance scheme kept in a position of solvency, but I cannot agree that the position of even an approved society is more important than that of an unem-
ployed individual who is cut off from benefit.
We are told that people must be dependent on the solvency or insolvency of the fund. That is the same old argument as was used in connection with unemployment. It has been continually urged that we should not pay benefits or give extended benefits to the unemployed because the fund was largely insolvent. But there is the question of the insolvency of the individual. People who are unemployed are drifting out of insurance not through any fault of their own but owing to the creeping paralysis coming over industry under a capitalist system, and if the State cannot give them insurance benefits or guarantees of medical attention and maternity rights for the women, I say the State is failing completely in its duty to the individual. I cannot differentiate between these people and many others in society. We do not hear it urged that the pensions paid to a large number of other people by the State—to Lord Nelson heirs—should be dependent on the solvency or insolvency of the State funds. We simply go on paying, we tax the community in order to provide for those people. What difference is there between providing funds for people whose ancestors, hundreds of years ago, were supposed to have given some service to the State, and the individuals who to—day are suffering under a declining system of capitalism which is unable to function?
The Minister said that no criticism had been made in regard to women. If the hon. Member for Gorbals (Mr. Buchanan), at least, and others who have spoken, did not allude directly to the case of the women, the resolutions put down on the Order Paper are so comprehensive that one can readily understand that they embrace all classes in connection with the Act. Another thing I want to point out is that there has been general agreement from all the approved societies, whether representing the ordinary friendly societies or trade union societies, about the reductions which have taken place. The Consultative Council of National Health Insurance Approved Societies, on which there are some eight members representing directly the trade union side, agreed to the reduced benefits and to the taking away of pension rights, medical benefits and maternity grants.
Those representatives were: Mr. L. Bowden, of the National Union of Seamen, Mr. G. W. Canter, of the Post Office Employes, Mr. A. Cook, J.P., of the Amalgamated Association of Cotton Spinners Operatives, Mr. A. G. Lee, of the Co-operative Wholesale Society, Mr. H. Lesser, of the South Metropolitan Gas Company's Employes, Mr. J. A. New-rick, C.B.E., of the British Iron, Steel and Kindred Trades, Mr. F. Thomas, J.P., of the Amalgamated Weavers Association, and Mr. W. Walker, of the Durham Miners' Association. Those individuals unanimously agreed to every cut that had been made by the Minister of Health. In addition to those, there were, from Scotland, Miss Jobson, of Airdrie, from the Farm Servants' Union, and Miss Eleanor Stewart, organiser for the Workers' Union and, at one time, a representative of the Labour party upon the Glasgow Town Council. Every one of them directly represented the workers in industry and in the trade unions, and they sat with the chairman of the Prudential Approved Society. They agreed that approved society funds are more important than the rights of the workers who are unemployed. That was simply because the general trade union attitude is that when you cease to be able to contribute to the trade union funds you become, not an object of defence, but largely an object of attack.
We therefore find in this Bill, if we couple it with the circulars sent out by the right hon. Gentleman who was the previous Minister of Health, in which he urged that the solvency of the fund was the important factor—not the preservation of the rights of the individuals concerned—a continuation of economies, and an attempt to keep the funds on a basis of solvency at the expense of the workers who are unemployed under the present conditions. For a Motion of this kind to be put down from the Labour Benches is outrageous, in view of the attitude of the members and adherents of that party who hold paid posts in the approved societies and who have contributed to the crushing down of unfortunate individuals into the gutter of poverty and despair. That is nothing but the Dr. Jekyll and Mr. Hyde attitude that is seen continuously in politics. You cannot come to this House and divorce your
action here from the general ideas of the great body of people who are contributing to, and who are generals of, the Labour army. You cannot dissociate yourselves here, in Opposition, from the things that you were doing when you were the Government of the day. If we put together the cuts in benefit, the means test, the cuts in Civil Service salaries and in social reforms, the agreement in regard to the means test in municipal housing, agreed to by Labour party representatives, and then these cuts, you could simply say that there was an attempt in this House to make the great body of workers outside believe that there was no responsibility for the things that are being carried on under the name of economy by the National Government.
I condemn the economies, as being the most brutal and outrageous thing that we have ever seen in capitalist society. Not only have you attacked the employed and the unemployed, but you have attacked the sick. You say to the poor woman who is going down into the shadow of death to bear a new life: "The State and Capitalism cannot give employment to your husband, and because of that we are compelled to take away the 40s. grant that is going to succour and sustain you in your hour of need." Capitalism can only be saved by the plundering and robbing of that poor woman in her hour of trial and tribulation. In connection with medical benefit, it has been stated here that the public assistance authorities will provide medical attention. I have seen the public assistance medical attentions, and from time to time I have had complaints from individuals who have gone at 9.30 in the morning, asking that a medical man should be provided to safeguard the health of the family, and had to call in a private practitioner at 9.30 at night, 12 hours after attempting to get the public assistance medical man for their children who were in danger of death. The public assistance doctors have said, "Why the hell cannot you public assistance people come at a certain hour of the day" Those people are treated something like social lepers. You are urging that those individuals should be thrown on to those who will treat the patients for whom they are paid in a
more generous way first, and who will then consider the health and wellbeing of those people afterwards. I am not expecting a great deal from the Liberals, the Tories or the Labour party, because I believe that the Labour party ought to be in the National Government. Their minds are the same as those of Members of the National Government. There is only a, difference in them while they are out of office. I cannot differentiate them in any shape or form. For them to come here to—day in the guise of the defenders of the working class, ought to get 5s. in Punch.
There is also the question of the medical rights of the individual. There is a large section of people who arc very concerned about their chance of a medical man. In the case of a woman in childbirth, it gives her confidence if she is able to go to the man who has been selected, knowing that she can pay him with the maternity grant. If she is compelled to go to the public assistance committee, she will get a man who will be rushed in his ordinary employment, and she will be treated at the tail end of all the ordinary business. She will not get the consideration that she would get if she were able to select her own doctor. For a woman at that stage, confidence is a very great thing indeed, because her whole nervous system is in such a state of tension that a lack of confidence in her medical man adds to her troubles, difficulties and dangers. If we analyse the figures, we find that maternal mortality went up last year. That is largely due to the unemployment in this country, and to the conditions surrounding working-class homes.
I am speaking particularly of Scotland. I think that it is a most disgraceful thing that, while we are discussing a subject that has been considered by various authorities in Scotland, including insurance committees, working-class bodies and public bodies, there is not a single representative of Scotland on the Government Bench, although the Under-Secretary looked in for five or ten minutes. I have not seen one National Government representative for the city of Glasgow here, while this discussion has gone on. I want to protest in the strongest manner against the Scottish Office treating this Motion with contempt by refusing to appear and to offer some defence of Scottish interests. It is no wonder that people
are lacking, to a large extent, in faith in politics, when they see the contempt with which their representatives are treated in this House.
I could add considerably to the discussion, but I recognise that there are other hon. Members who are desirous of speaking. I will only add my protest, to the protests that have been made today, against the implications of this Act, which we realised at the time. If the working-class representatives within the Labour movement had been doing their duty, they would have brought forward the agitation from the trade union approved society side long before the Act was put into operation. In spite of what the Minister says, I do not believe that this country realises the complete implications of this Act. Therefore, as time goes on, and people find that maternity grants are going, that pension rights are going, that there are reductions in medical benefit, and that medical rights are all gone, they will see in that a part of the general policy to economise at the expense of the poor, to keep those at the top of the social tree immune from further taxation for the purpose of bearing the wreckage of a declining system; and we hope that as time goes on the working class will develop their intelligence and consciousness, that they will be galvanised into action in this country, and that, instead of having faith in political parties and in Front Benches, they will have faith in themselves and march forward towards a general revolutionary upheaval to overthrow capitalism and set a decent system of society in operation.

3.6 p.m.

Sir FRANCIS FREMANTLE: The House always enjoys a really sporting feeling in looking upon Athanasius contra mundum—in triplicate—in the person of the three Members of the Independent Labour party, who have some difficulty in asserting their position of disagreeing with the official Labour party while officially agreeing with them on the particular Motion that is before the House. I should like to thank the hon. Members for Gorbals (Mr. Buchanan) for his generous tribute to the work of the medical practitioners all over the country. That is the one subject on which I desire to speak now.
The Minister, at the end of his speech, brought in a point on which the medical profession feel most strongly in this connection, namely, as to what is going to happen to those 80,000 or 100,000 people who will fall out of medical benefit at the end of this extended period, and who will have to be transferred to other doctors. I was sorry that my hon. Friend the Member for Mitcham (Sir R. Meller) seemed at one part of his speech to consider that this was quite satisfactory— that, as long as any man, woman or child had attendance of a certain quality, that was quite sufficient, that it was like dealing out a bottle of medicine, which could be dealt out quite as well by the Poor Law doctor as by the panel doctor, and that there was no real difference. My hon. Friend was inclined to appreciate the work of the Poor Law medical officers, and I myself would not in any way depreciate it, but there are certain parts of the country where local authorities and public assistance authorities have inherited old appointments and systems from the old guardians, and where the guardians did not wish to disturb arrangements which had been previously made and which went on from year to year and from decade to decade. Those fixed appointments were in certain cases by no means satisfactory; the Poor Law authorities got by no means the best men in the profession locally to undertake this poorly paid and hard-worked employment. The result, as everybody knows, is that the Poor Law medical service is not the equivalent of the panel service.
That is not because the individuals are different; we know that great objections have often been raised in this House to some parts of the panel practice. It is not the fact that you have one grade of men and another grade of men. It is not always a question of different grades of medical practitioners in these different services, but you have this very great difference, that, under the Poor Law, there is a fixed, definite appointment of one man, or of one or two men, in any particular area, and everyone has to go to the appointed officer and no other. Under the panel system we have established the choice of doctors, and that is the one thing which is an element of progress, and the one thing that enables the service to adapt itself to requirements
automatically, because, if the medical man does not give the service that is required by the patient, he can Change his doctor. It gives competition, it gives a kind of free trade in medical practice which is all to the good and is sure to give the greatest satisfaction that you can get under the National Health Insurance system. You cannot get it from the public assistance committees under the present arrangements. We were delighted to hear from the Minister that there are three areas already where the public assistance committees have undertaken the open choice method of medical attendance. Where that happens we are, I hope, arriving at an ideal which is being worked out, namely, that there should be only one system of medical attendance under the State, that is the open choice method, open to all the medical practitioners who undertake the terms of the panel, and those terms should be open to every single one of the individuals who come within whatever measure it is, National Health or the public assistance work, or any other service that may be created, such for instance as the new assistance that we shall be speaking of under the Unemployment Insurance scheme next Session. But that is being adopted for three areas only. In the great mass of areas that is not the case.
This is really a reform of the greatest magnitude in the improvement of the medical service and the health of the people in the whole of the country, and it has been adopted by simple mutual agreement in three areas. Would it be possible for the right hon. Gentleman to hasten that general application to the rest of the areas? He said he was going to ask the public assistance committees to make this system applicable more generally. I would ask the Parliamentary Secretary if he could do a great deal more than that. Is he going simply to wait for occasional areas where by the public spirit of one or two of the medical professions and one or two individuals on public assistance committees they are able to raise the question or is he really going to take this up and get it adopted throughout the country? If he does, he will have an enormous improvement in the general condition of the health of the people and, I believe, that will to a
large extent do away with the grievance that otherwise exists that people who have been insured under one system or the other because they have fallen out of the jealously guarded system of insurance have to go to another set of medical men who do not understand their conditions, and have not their dossier, over whom they have no choice and, when they go back to insurance, they will go back to their panel doctor again and will thus be jockeyed about between the two. I hope some idea will be given us that this general system may be adopted by mutual arrangement all over the country and in that way one of the main arguments for the Resolution will be met with very great effect.

3.15 p.m.

Mr. ARTHUR GREENWOOD: I think that the Debate to—day has been well worth while, not because we have obtained concessions of any magnitude from the right hon. Gentleman, but because it has brought into the Chamber a discussion on what is a most extraordinarily important question raising very large and important principles. The Minister in his speech made two points. He quoted the support obtained for his proposals, and he repeated, and attempted to justify, the arguments which he used when the National Health Insurance Bill was before the House last year. My hon. Friend the Member for Aberdare (Mr. G. Hall), who moved the Motion, referred to the views of insurance committees. The Minister retorted that of course they were not specially interested in the financial aspect of National Health Insurance. It is true that they are interested in the social implications of the Acts, and the Minister said, "Look what a list I have got. Wonderful people, who have all supported the Measure which the Government brought forward." He included in that list, followed by cheers from hon. Members opposite, the General Federation of Trade Unions, but he was not able to quote the Trades Union Congress. Perhaps Members on the other side of the House do not realise exactly the status of the General Federation of Trade Unions in this country, but it is no doubt true that large numbers of bodies, particularly those whose primary business is insurance with all its financial aspects supported the proposal. It
has been said that trade unionists who officially represented trade union approved societies also supported the proposal of the right hon. Gentleman. It is very difficult for me to speak of this matter because I understand that the discussion took place at a meeting which was not a public meeting, but a meeting of the Consultative Council of the Ministry of Health. Some people had means of inspiration open to them and were able to give names of those who actually voted against it. I am assured that none of the trade union representatives—I am sorry to have to say this—on the Consultative Council was in favour of any single proposal contained in the Health Insurance legislation of 1932.

Mr. McGOVERN: One trade union Member said so. In the "National Health Insurance Gazette" Mr. Newrick, whom I have quoted, said that the general support of approved societies on the trade union side had never been disputed by their trade union societies.

Mr. GREENWOOD: It is very difficult for me to deal with one sentence drawn from its context.

Mr. McGOVERN: I will read the whole letter.

Mr. GREENWOOD: As Mr. Newrick's name has been mentioned, I may say that I am informed that he never gave any support of any kind to the proposal of the Government.

Mr. McGOVERN: It is here. He says he supported it. Surely, he knows better than the right hon. Gentleman.

Mr. GREENWOOD: I do not wish to quote Mr. Newrick at length. I could do so if I liked. I have correspondence about it and I accept Mr. Newrick's word as given to me. I have no knowledge of whatever else he may have given. I want to make it clear that as far as my information goes trade union representatives interested in Health Insurance did not support the Bill. As regards the substance of the Motion, and of the 1932 Act a good deal of the speech of the Minister was devoted to trying to soften the blow. That in itself was an admission that this Bill has created hardships. There would have been no need for that if it were not a fact that a number of people are being adversely affected by the operations of the Act. There can be
no doubt about that. The right hon. Gentleman mentioned one concession, which he was not good enough to explain in any detail, which may or may not be a substantial concession but which appears to me to be of relatively small importance. The point I want to make is this, that the right hon. Gentleman has been trying to ease the position and he could only have done that under the pressure of facts as regards existing hardships. Therefore, the first part of our case is true, that the effect of this long-drawn-out period of economic depression and the effect of the Act passed last year has been to inflict hardships upon a number of insured persons.
The right hon. Gentleman tried to put up two opposing points of view. He stands, first and foremost and all the time, for the financial stability of the Health Insurance scheme. I am prepared to stand by it. I do not mind the circular being quoted, as it has been quoted by the hon. Member for Shettleston (Mr. McGovern). If in times like these, to protect benefits, efficiency can be improved or waste excluded, that is right, but I should have preferred the scheme to have carried on in the old way. There is the point that the sacrosanct principle of insurance may have to go in the face of wider social considerations. I am not an insurance expert, but I know that the whole meaning of insurance altered once it became compulsory. Under voluntary insurance actuarial considerations arc the final word, but where you have a compulsory scheme to which large numbers of people are to contribute and a large fund to which the State itself makes grants, that is merely a poll tax in another form.
It is perfectly right that those who manage the scheme should attempt to keep the budget balanced, but there is nothing sacred at the present time in the share which the different parties to the scheme contribute to the fund. It is undoubtedly true that when the last Conservative Government readjusted the contributions and reduced the State's contribution, our very high insurance experts did not rise in the House and say: "This is monstrous. This is killing the financial basis of the scheme. This is destroying the principle of insurance." They applauded it because it meant that less was going out of the Treasury into the Insurance Fund. If it was possible
without destroying the financial stability of the fund and destroying the principle of insurance to reduce the State contribution some years ago, it would be possible now for the State to make a contribution to deal with this very great problem without in any way cutting into the sacred principle to which hon. Members opposite pay so much deference.
The price which we are to pay for the salvation of the principle of insurance is that numbers of people are going to be driven to the Poor Law. That is a dreadful price to pay. This Government have balanced its national budget and the right hon. Gentleman is now engaged in trying to balace the budget of the National Insurance Fund. But there are elements in the process of balancing which do not appear on the surface and one of them is the spectacle of old workers passing their last milestones of life and seeing nothing but the workhouse in front of them. We should prefer the scheme to be carried on as it was. We prefer that it should be financially stable.
We do not pretend that there is any close analogy between national health insurance and unemployment insurance, there never has been, and there never will be; they are entirely different. One was a scheme started under favourable conditions which has been able to ride the storm with relative success. The other was a scheme started in the middle of a great economic crisis, on a large scale. It has never been an insurance scheme, but a compulsory taxation of employers and workpeople with a levy from the State. We should have preferred the Government to have kept national health insurance on its own financial basis, but having lost its financial stability, we should not have regarded it as destructive of this principle if the State had come to the assistance of those who are now to be deprived of benefits which they have enjoyed in the past. These benefits are now part of the warp and woof of the life of the people, part of the standard of life of the people, and are essential to the maintenance of the standard of life. If these services go, as respects only a handful of people, then to that extent there is a degradation of the standard of life of the masses.
What we are going to get by a continuation of this scheme is a permanent
pauperisation of people who are the victims of circumstances over which they have no control. It is all very well for the Minister to talk about areas where panel doctors are now being used for Poor Law purposes; it would not affect our attitude one iota if the whole panel services were mobilised; it is the contact with the Poor Law to which we object, not the quality of the service. If the hon. Member for St. Albans (Sir F. Fremantle) were able to mobilise all the panel doctors it would not be the same, because instead of the insurance doctor whom they can meet and look straight in the face there would be a new contact with the Poor Law. Those who know working-class life know that there is nothing more hateful to any member of a working-class family than to come into contact with the Poor Law. That is being done to—day, and it is a very heavy price to pay in order that the Exchequer may save what is a relatively small sum of money. This is part and parcel of the Government's permanent policy and has to be taken in connection with the Unemployment Bill which we are to discuss shortly. The year 1934 is going to re-impose on scores of our people the principles of 1834. It is being done here, and because we feel intensely the humiliation and degradation which is being imposed on people just as good as hon. Members of this Rouse, and the unnecessary hardship which will be caused in order to save a very small sum of money, that we have put down this Motion and intend to drive it to a Division.

3.30 p.m.

The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Mr. Shakespeare): Before I reply to the right hon. Gentleman let me try to clear up some misunderstandings, at which I am not surprised, on some of the issues involved in this rather complicated matter. There are two questions involved in this Motion. There is, first of all, the question of the falling out of medical benefit at the end of this year, and out of their insurance rights, except pension rights, of the 80,000 persons. There is the other question, to which so many speakers have referred, of the right of the ordinary insured person, and not this particular class of 80,000 persons. Let me try to explain what my right hon.
Friend the Minister has already pointed out, that every insured person is entitled, if he has lost his employment, to a free run of insurance of two-and-three-quarter years on the average. He will get full medical benefit and maternity benefit during that time.
Now as to arrears. During that time he gets cash benefit or sickness benefit provided that in the contribution year which runs from July to July he has paid the requisite amount of contributions or has sufficient credits; he receives sickness benefit in the calendar year next following. The contribution year is from July to July and the calendar year of course from January to December. What happens if he falls into arrears? His two-and-three-quarter years entitlement to free insurance is not affected. All that is affected is the rate of his cash benefits for the benefit year. Let me repeat what the Minister has said. A man who is unemployed has to find 20 contributions in a contribution year to qualify for cash benefits in the subsequent calendar year. The normally employed man will pay is. 6d. a week, of which 9d. is for health. If he is unemployed the Treasury has forgiven him his 9d. payment in respect of unemployment. Therefore, he need only pay 9d. in respect of health insurance. But the 1932 Act excused half his arrears in respect of the proved period of unemployment. If he is unemployed the whole of the 52 weeks, he has 26 contributions to his credit in respect of the contribution year. In effect any unemployed man has only to pay 4½d. a week in order to qualify for full cash benefits in the subsequent calendar year.
Let me explain that further. I have already referred to the 20 contributions. A man gets in respect of the unemployed weeks one credit for every two weeks of proved unemployment. He gets 36 credits, that is to say, 20 contributions and 16 credits. If he does that he is absolutely safe for some kind of sickness and disablement benefit. Anyhow he has his full medical benefit and full maternity benefit, and any additional benefit which the approved society may give him. My right hon. Friend pointed out that after the Act of 1932 the approved societies were allowed or rather were encouraged to devote their surpluses, which normally go to additional benefits, to providing moneys for the payment of
the arrears of their members. I cannot for the moment say whether in Lancashire the particular approved society referred to by the hon. Member for Ince (Mr. G. Macdonald) is using that concession, but there are in Lancashire many, or at any rate some approved societies or branches that have so acted and 3,500 approved societies or branches have paid in respect of their unemployed members arrears amounting to 40,000,000 weeks.

Mr. G. MACDONALD: How many have paid it in the case of the miners?

Mr. SHAKESPEARE: My right hon. Friend has dealt with that point. He pointed out that more than half the insured male population have had this concession made for them by their approved societies. I cannot obviously say how many cases there are of miners. That is as to the first concession—the one about additional benefit. The second concession is the issue of instalment arrear cards by means of which a man can put aside 4½d. a week when he gets a week or two of work. The third concession is the period of grace, and there is some misunderstanding about this point. The contribution year being from July to July a man is normally allowed up to 30th November to make good any arrears in the contribution year—that is to say he has a period of grace from July until 30th November. My right hon. Friend in consultation with many experts was informed that it would be a considerable help to a large number of men if a further period of grace were to be given.
Anyone who knows these matters as the hon. Member for the Scotland Division (Mr. Logan) knows them will agree —we are not discussing party politics but insurance now—that it will be a considerable help to extend the period in which the man may make good his arrears from 30th November to 31st March following. How does that concession operate? When the calendar year starts on 1st January, 1934, the man's position will be safeguarded if between 30th November and December he has paid off the arrears. In that case he will be all right. There is always a short waiting period, but assuming that he has paid off his arrears before 31st December he is all right for the full cash benefits for 1934. If he has not,
he goes on at the old rate. If he is allowed up to 31st March to pay off the arrears, I think that will be generally acceptable to all those who have in their constituency unemployed men who are trying to pay off these arrears.

Mr. LOGAN: In the intervening period from nOth November until 1st January if arrears are cleared off that automatically puts him into full benefit in January, 1934; and that being so from the point of view of administration, what is the position when a person makes application for benefit not having paid up the arrears on 1st January? Is he to have a period of grace given to him up to March, or must he have paid or must there be any time before he can claim?

Mr. SHAKESPEARE: What the hon. Member wants is a period of grace within a period of grace. Of course there is always a period of waiting. It is perfectly plain that if a man at the start of the year has paid off his arrears, subject to a short waiting period, he is all right. If he has not paid off his arrears he is given up to the 31st March to do so. As soon as they are paid off, his rate of sickness benefit will be readjusted.

Mr. LOGAN: Automatically?

Mr. SHAKESPEARE: Yes, automatically.

Mr. LOGAN: No waiting period.

Mr. SHAKESPEARE: There is always a short waiting period. Now let us get on. There is another point which is not usually appreciated by the House, and it arises under the so-called iniquitous 1932 Act. It is made perfectly easy for a man to re-enter. Let us suppose that he is one of these 80,000 men who got eight weeks' work any time in two consecutive half years. He will go on for another 2 3/4 years receiving benefit. Let us suppose that one of the 80,000 persons has exhausted his Health Insurance rights. He has only to do eight weeks' work in two consecutive half years and will again get 2 3/4 years' full medical insurance rights, and, instead of having to pay 104 contributions like anyone who has come into the Health Insurance scheme, he has only to pay 26. I do claim that we have made it as easy as possible for these men, for whom we all
have sympathy, to come back into insurance on very generous terms.

Mr. CLARRY: That does not meet the situation of men who are out of work and do not get employment to enable them to pay eight, 16 or any number of weeks. Are they to continue in perpetuity to be out of benefit

Mr. SHAKESPEARE: Is my hon. Friend talking about the 80,000?

Mr. CLARRY: Yes.

Mr. SHAKESPEARE: Then let us take this case. Some of these men have been unemployed since 1920. Every week since 1920 not one contribution has been paid in respect of their Health Insurance. For 12 years you have maintained a scheme for 17,000,000 persons. You have said to the 17,000,000 persons, "As you pay you shall receive. As you sow you shall reap." Are you to say to this specially privileged body of men. "Whatever you have paid it does not matter "? Here is an insurance scheme which every Government has treated as a self-supporting scheme. I have never heard a Minister of any party standing at this Box making a suggestion to undermine the solvency of this scheme. When my right hon. Friend reviewed the question last year, he came to the conclusion that you could not, in law or in equity, maintain 80,000 persons who on an average have not paid 2½ years' contributions in 10 years, but you must not knock them out of insurance straight away. Sickness benefit went on until December, 1932, and their medical benefit will go on until the end of this year, while every one of these 80,000 men is granted pension rights until 1935.
I am surprised, almost shocked, at the hon. Member for Gorbals (Mr. Buchanan), in the very eloquent speech that he made, talking about a hardship on the poor newly-married man, one of the 80,000, who died and whose widow was left nothing. He said it was going to happen now, but that widow is protected now, and every widow of all those 80,000 will be treated in exactly the same way as anybody under the full scheme. He also raised the old question of the man of 60 and the man of 58, and how he found a man of 58½ who had pawned something at Kilmarnock. I was at Kilmarnock too, hut the point that I should have made at
Kilmarnock was that before the 1932 Act a man might have been within one month of his 60th birthday, and if he had fallen out of employment, his pension rights would not have accrued to him at 65 under the scheme, but that after the 1932 Act a man had only to get to 58¼, and thereafter, if he was employed at 58¼, his pension rights were absolutely secured under the scheme at the age of 65. So far from the Act of 1932 worsening the position, it has made it very much better, and I am surprised that the hon. Gentleman did not make that point at Kilmarnock.

Mr. BUCHANAN: The point is this, and it has been run away from time and again: Before the 1932 Act was passed every man who had his card stamped, whether he was 60, 58, or 55, was kept within insurance each year by prolongation, and no difference of age was made. This Act for the first time comes along and says, "If you were under the age of 58¼ as at the last date your stamp was put on, then, unless you can get succeeding work, you pass out of pension rights as from 1935."

Mr. SHAKESPEARE: That is not true.

Mr. BUCHANAN: It is true.

Mr. SHAKESPEARE: That is the short and simple answer. The answer is exactly as I have stated, that the 1932 Act gave a very good concession.

Mr. BUCHANAN: It gave no concession.

Mr. SHAKESPEARE: In respect of a man who hitherto, if he was 591 and had lost his job—

Mr. BUCHANAN: May I say

Mr. SHAKESPEARE: I do not want to give way again.

Mr. BUCHANAN: You yourself quoted a man 10 years unemployed.

Mr. SHAKESPEARE: Before the 1932 Act a man of 59 3/4, if he fell out of employment, lost his pension rights under the scheme, but after the 1932 Act a man of 58¼, if he fell out of employment, was guaranteed his pension rights at 65.

Mr. BUCHANAN: No.

Mr. SHAKESPEARE: Those are facts that the hon. Member cannot dis-
prove, but once again let us get on. As regards these 80,000 persons, the House last year took the decision that it did because it agreed with our view that you cannot have a privileged class. You cannot say to "A," "Go on paying, and you will get back what you have paid," and to "B," "Whatever you pay or do not pay, we are going to keep you for ever." That is Poor Law. Do not let the House muddle up Health Insurance and Poor Law. You are thereby doing no service to the 17,000,000 insured contributors who pay week by week, under well-known conditions, and I beg the House to reject this Motion for that reason, that this Health Insurance Fund is something very precious. The whole scheme is very precious. It is the most generous scheme in the world, and it has been kept solvent for the very reason that we have always resisted the same attack on it as has been made on the Unemployment Insurance Fund.
It is all very well to say that the State should bear the cost of medical benefit. The Trade Unions want their cash benefit paid too. That asking the State to bear over £2,000,000 extra. It is the old principle which I have heard so often in this House—the State must pay a little more and that the insurance scheme must he solvent, but only solvent by the State going on year after year paying more money until the whole principle laid down by the founders of the scheme is undermined. I ask the House to take a business view and not a sentimental view of What is a business transaction. I want to say one word in reply to my hon. Friend the Member for St. Albans (Sir F. Fremantle). What happens to these 80,000 men when, at the end of this year, their medical rights are exhausted? The answer is, as everyone knows, that they will be treated like anyone else who is not within the insurance scheme. They will be treated like the 500,000 persons who fall out of insurance every year. They will be treated like those people who have never been in insurance. Assuming that the number is 80,000, that means that on average over one quarter will claim for some form of sickness or be incapacitated by some form of sickness.
The cost, therefore, should not be exaggerated. It does not mean that 80,000 persons must be thrown on to the medical side of public assistance. It
will probably mean that about 20,000 will at some time of the year have recourse to the district medical service. I really must challenge the hon. Member for St. Albans who suggested that the district medical service was inferior to the panel service. I deny it for the simple reason that in, for instance, any county borough divided into medical districts, the general practitioners themselves carry on the district medical work. When Mr. A, who has chosen his own panel doctor, goes to the public assistance for medical treatment, he might even be sent back to his own panel doctor. If he is not, he will be sent to somebody else's panel doctor in the great majority of cases. It is a slur on the district medical service to say that this service is inferior to the panel service. In the great majority of cases people are treated by the same doctors as those in the panel service, and I resent the slur that is thrown on the district medical system.

Mr. LOGAN: I take it that it is the Minister's intention to set up a State service or local service of panel doctors to deal with these particular cases? If that be so, what about those doctors who

are already occupying the position, and what compensation will be given them for disturbance of office?

Mr. SHAKESPEARE: My right hon. Friend dealt with that. He showed that there are three places where a panel system is in operation. He is putting no bar to the extension of that principle. It is in the experimental stage, but, if there is a real objection to it, my right hon. Friend will do his best to meet what may be a real difficulty. I ask the House once more to adopt the attitude laid down in the very admirable speech of the hon. Member for Mitcham (Sir R. Meller), and to maintain the distinction between Health Insurance and poor relief.

Question put,
That, in the opinion of this House, the hardships arising from long-continued unemployment will be unduly aggravated by denial of the benefits conferred by the National Health Insurance and Contributory Pensions Acts, and, therefore, provision should be made for a State contribution towards safeguarding the position of those insured persons who are victims of the present industrial depression.

The House divided: Ayes, 48; Noes, 161.

Division No. 300.]
AYES.
[3.55 p.m.


Adams, D. M. (Poplar, South)
 Evans, R. T. (Carmarthen)
McEntee, Valentine L.


Attlee, Clement Richard
George, Major G. Lloyd (Pembroke)
McGovern, John


Banfield, John William
George, Megan A. Lloyd (Anglesea)
McKeag, William


Batey, Joseph
Greenwood, Rt. Hon. Arthur
Maclean. Nell (Glasgow, Govan)


Bevan, Aneurin (Ebbw Vale)
Grenfell, David Rees (Glamorgan)
Maxton, James


Buchanan. George
Grundy, Thomas W.
Milner. Major James


Cape, Thomas
Hall, George H. (Merthyr Tydvll)
Parkinson. John Allen


Clarry, Reginald George
Harris, Sir Percy
Price, Gabriel


Cocks, Frederick Seymour
Hirst, George Henry
Smith, Tom (Normanton)


Cove. William G
Holdsworth, Herbert
Tinker, John Joseph


Crooke, J. Smedley
Janner, Barnett
Wallhead. Richard C.


Daggar, George
Lansbury, Rt. Hon. George
Williams, Edward John (Ogmore)


Davles, David L. (Pontypridd)
Lawson. John James
Williams. Thomas (York, Don Valley)


Dobbie, William
Leonard, William
Wilmot, John Charles


Edwards, Charles
Llewellyn-Jones, Frederick



Evans, David Owen (Cardigan)
Logan, David Gilbert
TELLERS FOR THE AYES—


Evans, Capt. Ernest (Welsh Univ.)
Lunn, William
Mr. Groves and Mr. G. Macdonald.


NOES


Acland-Troyte. Lieut.-Colonel
Bowyer, Capt. Sir George E. W.
Denvllie, Alfred


Adams, Samuel Vyvyan T. (Leeds,W.)
Boyce, H. Leslie
Donner, P. W.


Albery, Irving James
Brocklebank, C. E. R.
Doran, Edward


Allen, Lt.-Col. J. Sandeman (B'k'nhd.)
Buchan-Hepburn. P. G. T.
Dugdale. Captain Thomas Lionel


Allen, William (Stoke-on-Trent)
Burnett, John George
Edmondson, Major A. J.


Applin, Lieut.-Col. Reginald V. K.
Cadogan, Hon. Edward
Elmicy. Viscount


Astbury, Lleut.-Com. Frederick Wolfe
Campbell, Sir Edward Taswell (Brmly)
Emrys-Evans, P. V.


Baldwin, Rt. Hon. Stanley
Campbell-Johnston. Malcolm
Entwistle, Cyril Fullard


Balniel, Lord
Caporn, Arthur Cecil
Ersklne, Lord (Weston-super-Mare)


Barclay-Harvey, C. M.
Castlereagh. Viscount
Fermoy, Lord


Barrie, Sir Charles Coupar
Clayton, Sir Christopher
Flelden, Edward Brocklehurst


Beauchamp, Sir Brograve Campbell
Cochrane, Commander Hon, A. D.
Fox. Sir Gifford


Beaumont, M. W. (Bucks., Aylesbury)
Colville, Lleut.-Colonel J.
Fraser, Captain ian


Beit. Sir Alfred L.
Cooke, Douglas
Fremantle, Sir Francis


Benn, Sir Arthur Shirley
Courtauld, Major John Sewell
Ganzonl, Sir John


Bossom. A. C
Cranborne, Viscount
Gilmour, Lt.-Col. Rt. Hon. Sir John


Bowater. Col. Sir T. Vansittart
Cruddas, Lieut-Colonel Bernard
Glucksteln, Louis Halle


Bower, Lieut.-Com. Robert Tatton
Dawson, Sir Philip
Glyn, Major Ralph G. C.


Goff, Sir Park
Margesson, Capt. Rt. Hon. H. D. R.
Russell, Hamer Field (Sheffield, B'tside)


Goldie, Noel B.
May hew, Lieut.-Colonel John
Rutherford, John (Edmonton)


Grattan-Doyle, Sir Nicholas
Meller, Sir Richard James
Salmon, Sir Isidore


Graves, Marjorie
Mitchell, Harold P.(Br'tf'd &Chisw'k)
Samuel, Sir Arthur Michael (F'nham)


Greaves-Lord, Sir Walter
Monsell, Rt. Hon. Sir B. Eyres
Sandeman, Sir A. N. Stewart


Guinness, Thomas L. E. B.
Moore, Lt.-Col. Thomas C. R. (Ayr)
Savery. Samuel Sorvington


Guy, J. C. Morrison
Moreing, Adrian C.
Shakespeare, Geoffrey H.


Hacking, Rt. Hon. Douglas H.
Morrison, William Shepherd
Shaw, Captain William T. (Forlar)


Hanley, Dennis A.
Moss, Captain H. J.
Skelton, Archibald Noel


Hannon, Patrick Joseph Henry
Mulrhead, Lleut.-Colonel A. J.
Smith, Bracewell (Dulwlch)


Harvey, George (Lambeth, Kenningt'n)
Munro, Patrick
Somervllle, Annesley A. (Windsor)


Headlam, Lleut.-Col. Cuthbert M.
Murray-Phlilpson, Hylton Ralph
Southby. Commander Archibald H. J.


Henderson. Sir Vivian L. (Chelmsford)
Nail-Cain, Hon, Ronald
Stuart, Lord C. Crichton-


Herbert, Capt. S. (Abbey Division)
Nation, Brigadier-General J. J. H.
Sueter, Rear-Admiral Murray F.


Hills, Major Rt. Hon. John Waller
Nicholson, Godfrey (Morpeth)
Sugden, Sir Wilfrid Hart


Hornby, Frank
North, Edward T.
Tate, Mavis Constance*


Howitt, Dr. Alfred B.
O'Donovan, Dr. William James
Thomas, Rt. Hon. J. H. (Derby)


Hudson, Robert Spear (Southport)
O'Neill, Rt. Hon, Sir Hugh
Thomas, James P. L. (Hereford)


Hume, Sir George Hopwood
Ormsby-Gore, Rt. Hon. William G. A.
Thomson, Sir Frederick Charles


Hurst, Sir Gerald B.
Penny, Sir George
Touche, Gordon Cosmo


Hutchison, W, D. (Essex, Roml'd)
Percy, Lord Eustace
Ward. Lt.-Col. Sir A. L. (Hull)


Jackson, Sir Henry (Wandsworth, C.)
Petherlck, M.
Warrender. Sir Victor A. G.


Joel, Dudley J. Barnato
Peto, Sir Basil E. (Devon, Barnstaple)
Watt, Captain George Steven H.


Lindsay, Kenneth Martin (Kilm'rnock)
Pike, Cecil F.
Wells. Sydney Richard


Llewellin, Major John J.
Powell, Lleut.-Col. Evelyn G. H.
Whiteside, Borras Noel H.


Lloyd, Geoffrey
Pownall, Sir Assheton
Whyte, Jardlne Bell


Lockwood, John C. (Hackney, C.)
Procter, Major Henry Adam
Williams, Herbert G. (Croydon, S.)


Lyons, Abraham Montagu
Ralkes, Henry V. A. M.
Wills, Wilfrid D.


Mabane, William
Ramsay, T. B. W. (Western Isles)
Wilson, Lt.-Col. Sir Arnold (Hertf'd)


McCorquodale, M. S.
Ramsbotham, Herwald
Wilson, G. H. A. (Cambridge U.)


MacDonald, Rt. Hon. J. R. (Seaham)
Rankin, Robert
Winterton, Rt. Hon. Earl


Macdonald, Capt. P. D. (I. of W.)
Reid, James S. C. (Stirling)
Wise, Alfred R.


McKie, John Hamilton
Reid, William Allan (Derby)
Wood, Sir Murdoch McKenzie (Banff)


McLean, Major Sir Alan
Ross, Ronald D.
Young, Rt. Hon. Sir Hilton (S'v'noaks)


McLean, Dr. W. H. (Tradeston)
Ross Taylor, Walter (Woodbridge)



Maitland, Adam
Runge, Norah Cecil
TELLERS FOR THE NOES.—


Makins, Brigadier-General Ernest
Russell, Alexander West (Tynemouth)
Captain Austin Hudson and Major George Davies.

The Orders of the Day were read, and postponed.

Whereupon Mr. SPEAKER adjourned the House without Question put, pursuant to Standing Order No. 3.

Adjourned at Five Minutes after Four o' Clock until Monday next, 13th November.